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PERSPECTIVES: How to Improve Communications with Health Plan Members

October 2nd, 2018 | by Stephen Billias

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Imagine a Medicare Advantage member thumbing through the Evidence of Coverage (EOC) document from his insurance company, struggling to find the information he’s looking for in this 200-page document. Now imagine this member works on building EOCs and other communications for health plans every day, and he still can’t find what he’s looking for.

That MA member/insurance document expert is me.

If someone who looks at these materials day in and day out can’t find the information that’s relevant to him, what hope does the average American have?

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4 ways to reduce – or eliminate – errors in your ANOCs and EOCs

September 20th, 2018 | by Stephen Billias

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The accuracy of Annual Notice of Changes (ANOC) and Evidence of Coverage (EOC) documents is an important requirement for all health plans. The Centers for Medicare and Medicaid Services (CMS) takes errors in these documents very seriously and penalties are given to health plans that distribute documents with errors.

CMS recently announced changes to the distribution of these documents. ANOCs and EOCs have been uncoupled, and electronic sharing of EOCs is now allowed. CMS has also reiterated the importance of distributing these documents on time and in compliance. Read more »


PERSPECTIVES: Combining Medicare and Medicaid into One Program

September 7th, 2018 | by Stephen Billias

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The status quo of government-sponsored health programs is beginning to fail. The government recently reported that Medicare will run out of money in less than 20 years unless drastic changes are made. But how can our health care system be altered to correct deficiencies and adjust to changing conditions, avoid a huge financial crisis in coming years, and make health care more affordable and secure for all Americans?

I believe that eliminating the distinction between Medicare and Medicaid, thereby combining them into one program, could be a viable solution.

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Dealing with Change in the Medicare World

July 20th, 2018 | by Stephen Billias

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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:

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What Sets CODY Apart from Other Consulting Firms

July 19th, 2018 | by site admin

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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?

June 14th, 2018 | by Doug Pray

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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

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3 Keys to a Successful Compliance Program

June 13th, 2018 | by Hannah LaMere

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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:

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Can Outsourcing Your Member Marketing Materials Production Pay for Itself?

March 27th, 2018 | by Brad Boyer

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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:

  1. Develop materials in-house, and outsource printing and fulfillment to a vendor; or
  2. 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?

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Are you Outsourcing your ANOC and EOC Creation to the Best People for the Job?

March 19th, 2018 | by Brad Boyer

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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

March 1st, 2018 | by Tonya Teschendorf

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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.

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