Topic: Part D

Partners Needed

Debra Devereaux

I calculated the total amount of civil monetary penalties (CMPs) levied by the Centers for Medicare & Medicaid Services (CMS) last year on Medicare Advantage and Part D plans, and it’s a big number: $4,925,150. There were also five suspensions in 2014.

Read more

Leave a comment | Share | |

Is the “NUNCMO” Nightmare Keeping You Up at Night?

Christine Tobin

The recent MAPD Help Desk Memo, dated 3/3/15, advises that on March 8, 2015, “The Centers for Medicare & Medicaid Services (CMS) will be performing a clean-up to process “73” transactions that contain NUNCMO (Number of Uncovered Months) value from the extraneous NUNCMO row that was removed in Phase 1 multi-phase NUNCMO data clean-up which occurred on March 23, 2014.  The effective start date of this transaction will be the preceding Part D enrollment start date.”

Read more

Leave a comment | Share | |

The Annual Full Replacement COB Files Are on Their Way

Christine Tobin

It’s that time of year again when Part D plans will receive full replacement Coordination of Benefits (COB) files from the Centers for Medicare & Medicaid Services (CMS).  The Health Plan Management System (HPMS) memo dated 3/6/15 states that the 2015 Full Replacement COB files will be sent to organizations beginning March 19th.  Plans will need to distinguish these files from daily COB notification files by the date of receipt and the file size. Easy enough? Not exactly. 

Read more

Leave a comment | Share | |

Key Changes to Star Ratings from 2016 Draft Call Letter

Melissa Smith

Now that the news from last month’s 2016 Advance Notice (also known as “the Call Letter”) from the Centers for Medicare & Medicaid Services (CMS) has had time to sink in, it’s time for the real work to begin.

Read more

Leave a comment | Share | |

Is This Condition For Real? CMS Compliance Program Audit Findings Tied to FDR Oversight

Regan Pennypacker

There is no shortage of concern when it comes to awareness of first tier, downstream and related entity (FDR) oversight. In fact, during a recent webinar hosted by John Gorman, Executive Chairman at GHG, and Betsy Seals, Chief Consulting Officer at GHG, on “The Top 10 Things Killing Your Organization”, we shared survey results showing the number one Compliance Program risk, from a health plan’s perspective, is FDR oversight.

Read more

2 Comments | Share | |

Formulary Submission Reminders

Lynne Civin

The reprieve of Plan Sponsors having only one set of calendar year (CY) formularies to maintain is coming to an end. It’s that time of year where, in preparation for CY 2016 formulary submission, Plan Sponsors are diligently assessing their formulary and benefit structure to optimize beneficiary access to formulary drugs while leveraging cost containment strategies. 

Read more

Leave a comment | Share | |

Industry Ducks Bullets in 2016 Medicare Advantage Rate Proposal

John Gorman

Friday, February 20th after close of business, the Centers for Medicare and Medicaid Services (CMS), released its 2016 Advance Notice of Medicare Advantage Payment, known affectionately as “the call letter.”

Read more

2 Comments | Share | |