Topic: Part D

Gorman Health Group Client Forum Takeaways: Government Programs are Booming, Bar is Rising

John Gorman

We just wrapped our best-ever Gorman Health Group 2015 Client Forum at National Harbor with over 200 of our closest clients and partners.  There was both great and tough news, so here’s a few takeaways, including a couple stunners: Read more

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The Risk in DIY: CMS Mandated Material

Regan Pennypacker

“Do It Yourself”, or DIY, has been the rave for years now.  From social media sites like Pinterest to television networks like HGTV, Americans have become fond of this philosophy.  Now, I am a big believer in being self-sufficient and must say that I have been sucked into marathon viewings of DIY shows often (Nicole Curtis of Rehab Addict is no joke!).  And, while I have seen my share of success stories, more often than not, I see DIY projects result in complete frustration from those attempting to DIY and very costly mistakes.

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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.

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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.”

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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. 

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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.

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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.

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