The healthcare world and Medicare health coverage are in a state of rapid and uncertain change. What can health plans and those serving health plans, such as pharmacy benefit managers and even consultants, do to be ready for both anticipated and unanticipated changes?
Here are some of the issues facing the industry in today’s turbulent environment, and some suggested solutions to these difficult, change-driven dilemmas:
What Sets CODY Apart from Other Consulting Firms
Health plans have many options when searching for a consulting partner to help streamline operations and/or outsource key business functions – and not all of them are created equally. There are certain traits to look for when hiring a great consulting partner and many will check most or all of these boxes.
So, what sets CODY apart from others in the field? Read more »
What Does CMS’s New Rule Regarding Electronic EOCs Mean for Health Plans?
In its 2019 annual notice, The Centers for Medicare & Medicaid Services (CMS) issued regulatory changes that impact how and when health plans must provide Evidence of Coverage (EOC) documents to members.
What the Rule Allows
The rule brings the following major changes to Medicare Advantage Organizations (MAOs), Medicare Prescription Drug Plans (PDPs), and section 1876 Cost Plans:
- The Annual Notice of Change (ANOC) and the Evidence of Coverage (EOC) documents are now two independent documents with different delivery requirements and flexibilities. Beginning with Contract Year 2019, ANOCs and EOCs no longer need to be combined in the mailing due to members by September 30.
- Health plans may now share EOCs electronically rather than printing and mailing the documents
- Health plans will now have until October 15 to either ensure receipt of the EOC by members, or provide EOCs electronically
3 Keys to a Successful Compliance Program
Complying with state and federal rules and regulations is a challenging endeavor. It requires health plans to manage a slew of different processes and resources. Missteps pose risks that could result in compliance violations, fines and a drop on CMS’s Five Star Quality Ratings.
Some of the most difficult areas to manage, from a compliance standpoint, include staying abreast of CMS updates and other regulatory requirements, producing error-free member marketing materials, and proper investigations management.
To get a handle on these biggest compliance challenges, health plans can start by mastering the three keys to a successful compliance program:
Can Outsourcing Your Member Marketing Materials Production Pay for Itself?
Many health plans are currently considering how to manage creation and distribution of marketing materials due to members September 30. The reality is, health plans have two options:
- Develop materials in-house, and outsource printing and fulfillment to a vendor; or
- Outsource the entire materials production process – materials creation, and print and fulfillment – to a vendor
The prospect of not having to create materials in-house may appeal to many marketing directors. However, with health plans operating on tight budgets, many may think that outsourcing the entire process would be too costly.
But, if outsourcing your member materials production could pay for itself, wouldn’t it be worth considering?
Are you Outsourcing your ANOC and EOC Creation to the Best People for the Job?
Preparing materials for the Annual Enrollment Period (AEP) – namely Annual Notice of Changes (ANOC), Evidence of Coverage (EOC), and Summary of Benefits (SB) documents – can be a time-consuming, labor-intensive process wrought with compliance risk. As a result, many health plans opt to outsource the creation of these documents to a third-party vendor.
There are several benefits to outsourcing the creation of ANOC, EOC and SB documents. But not all vendors are created equally. Below are three things to look for when hiring a third-party vendor to create your ANOC and EOC documents. Read more »
How to Avoid FDR Oversight Issues in a CMS CPE Audit
First Tier, Downstream or Related Entity (FDR) Oversight continues to be a hot topic for the Centers for Medicare and Medicaid Services (CMS) and plan sponsors. CMS auditors annually find deficiencies in FDR oversight and monitoring activities in program audits, with poor oversight of FDRs trending as a common condition in yearly audits.
Many plan sponsors consider an FDR as a risk only if a problem materializes. This is a mistake. All FDRs are operational and compliance risks. The extent of the risk exists in the type of functions the FDR performs, potential and actual member impact, and FDR issues.
6 Traits of a Great Consulting Partner
In the world of Medicare and Medicaid, choosing a consulting partner to help streamline your health plan’s operations can be tricky. While a company or individual may be well-versed in best practices for project management or operational efficiency, they may not understand the unique requirements of the payer market – making them less than effective at addressing your needs.
With that in mind, below are six traits to look for when choosing a consulting partner to work with your health plan: Read more »
How CodySoft’s® Collateral Management Module® Compares to Other Project Management Tools
Our experts have seen it all when it comes to how health plan project managers handle the creation of required member marketing materials. Usually, it involves manually tracking projects using spreadsheets and email, using a generic, out-of-the-box project management software, or a combination of both.
Manual tracking can be extremely time-intensive and highly prone to errors. And even very robust software solutions can be overly complex while still missing the mark on what health plans really need to manage their projects.
What Health Plans can Expect in 2018
With a new year right around the corner, we asked our team of experts: What can health plans expect in 2018?
Listed below are a few issues health plans should be aware of and keep an eye on as we move into the new year. These cover the areas of compliance, technology, and member marketing materials creation and production.