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- Vern Smith on A Bad Couple Weeks for ObamaCare
- CARMEN MELCHOR on What Sequestration Could Mean to Medicare Advantage Claims Payment
- harry bailes on Medicare Advantage Showcased as the Model for Medicare Reform
- Naomi on What Sequestration Could Mean to Medicare Advantage Claims Payment
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Topic: Part D
In the October 8, 2014 memo entitled “Contract Year 2014 Part D Formulary Administration Analysis (FAA)”, CMS reiterates their concern with the accuracy of formulary coding. For the April 2013 analysis, 9 out of 88 (10.2 %) plan sponsors were found to have failed FAA, meaning that greater than 20% of the sampled rejects were determined to be inappropriate. The parameters for the 2014 FAA are: Read more
Rejected claim analysis is a year-round activity with special emphasis that should begin before January. Are you confident in your current process to review and identify non-compliant rejected claims?
Plans will shortly be receiving the Readiness Checklist from CMS. At first glance it looks like just a bunch of boxes to check off and answering yes and no questions. Here’s the rub:
The Medicare Payment Advisory Commission (MedPAC ), the nonpartisan blue-chip Congressional uber-nerds on our favorite entitlement program, met this week and the staff report presented a couple bombshells on retention rates in Medicare Advantage (MA).