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Best Practices for Language beyond the CMS Model Language

March 21st, 2017 | by Stephen Billias

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The Centers for Medicare and Medicaid Services (CMS) templates for the Annual Notice of Changes (ANOC) and Evidence of Coverage (EOC) contain extensive model language that is required and must be used by every insurer. However, there are also numerous places in these documents where health plans have latitude and flexibility to use their own language to describe benefits, cost-sharing, coverage limits and so forth. These areas provide significant opportunities for health plans to better communicate with their members, and thereby positively impact the member’s experience.

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The Secret to Simplifying Health Plans’ Member Marketing Material Translations: A Parallel Project Path

February 16th, 2017 | by Doug Pray

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We’ve seen first-hand the frustrations health plan project managers experience in translating their member marketing materials – including Annual Notice of Coverage (ANOC), Evidence of Coverage (EOC), Drug Formulary and Summary of Benefits (SB) – to additional languages.

The question for our CodyPrint® team became: What would give project managers visibility to the translation process, minimize the production timeline, and eliminate the iterative processes that increase the opportunity for errors in these materials?

The answer was a parallel project path for creating both the English and Spanish versions of these materials in lockstep. Rather than the conventional model where the health plan gives a translation company an English document to translate, the translation company does its work and then sends the translated document back, we developed a different methodology to create and revise English and Spanish documents in parallel.

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Industry Alert: Is Your Health Plan the Target of CMS’s New Audit Focus?

February 3rd, 2017 | by Brad Boyer

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Vikki Ahern, CMS Director for Medicare Part C/D Oversight and Enforcement Group (MOEG), spoke at this week’s 2017 HCCA Managed Care Compliance Conference. It served as a wake-up call for compliance professionals in attendance.

Although an explanation of CMS’s reasoning was not provided, Vicki Ahern stated that CMS will specifically target small parent plans for 2017 program audits. CMS will begin sending plan sponsor program audit notices on February 21, with audit start dates in April.

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3 Reasons the Conventional Method of Translating Member Materials Makes Project Managers Nervous

February 1st, 2017 | by Doug Pray

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Project managers are highly organized, detail-oriented people. Some may admit to being control freaks, but that’s what makes them good at their jobs. This is especially the case for project managers responsible for coordinating a health plans’ member marketing communications, given the level of complexity, time-sensitivity and risk involved in creating and distributing these materials.

Producing and distributing accurate, on-time Annual Notice of Coverage (ANOC), Evidence of Coverage (EOC), Drug Formulary, and Summary of Benefits (SB) documents in English is a feat worthy of celebration. But health plans required to deliver member materials in additional languages must deal with another set of issues before the party can begin.

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How a Medicare Advantage Voucher Program could be the Next Medicare Part D

January 30th, 2017 | by Deb Mabari

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With 10,000 Americans entering Medicare every day, the health plan industry continues to expand. In 2015, 55.5 million people were enrolled in Medicare. By 2020, that number is expected to increase to 64.4 million, and to balloon to 81.8 million by 2030.

Yet, of the current 55.5 million Medicare beneficiaries, only a third are enrolled in Medicare Advantage (MA) plans. There is plenty of opportunity for MA plans to grow – and it could happen sooner than most people think, especially if certain factors come into play.

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3 Ways Growing Health Plans can Avoid Adding FTEs

November 29th, 2016 | by Kevin A. LeBlanc

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Health plans today are feeling more pressure than ever before to do more with less. This is especially true now that health plans have to operate within the federal minimum medical-loss ratio (MLR) requirement. The minimum MLR requirements leaves health plans with only 15 percent of their Medical revenue to spend on administration, marketing, and, often the most expensive line item, employee salaries.

For health plans looking to bring on more resources to handle growth – for instance, moving from a small health plan to a medium-to-large health plan – the obvious course of action may be to hire more full-time equivalent employees (FTEs). However, adding FTEs comes with great expense. Salaries, benefits, workstations, equipment and other expenditures associated with FTEs add up quickly. In short, hiring more FTEs is not necessarily the most efficient or cost-effective next step for a growing health plan looking for scalable solutions.

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How Accurate ANOCs and EOCs can Help Health Plans Retain Members

October 14th, 2016 | by Kevin A. LeBlanc

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The Henry J. Kaiser Family Foundation recently published an Issue Brief on its website titled “Medicare Advantage Plan Switching: Exception or Norm?” The brief shared that 11 percent of Medicare Advantage plan enrollees in 2013 voluntarily switched to another plan in 2014. It also addressed various factors that impacted switches to other plans, such as the members’ age, rate increases and coverage changes.

In addition, research showed Medicare Advantage enrollees who voluntarily switched plans were disproportionately in plans with lower quality ratings. Between 2013 and 2014, 14 percent of enrollees in plans with 2 or 2.5 star quality ratings switched plans, while only 3 percent of enrollees in 5 star plans switched. The article states, “These findings suggest that factors related to the star ratings may cause some beneficiaries to switch plans.”

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7 Tips for Recruiting your Magnificent 7

September 21st, 2016 | by Stephanie Krebs

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(l to r) Vincent D'Onofrio, Martin Sensmeier, Manuel Garcia-Rulfo, Ethan Hawke, Denzel Washington, Chris Pratt and Byung-hun Lee star in Metro-Goldwyn-Mayer Pictures and Columbia Pictures' THE MAGNIFICENT SEVEN.

(l to r) Vincent D’Onofrio, Martin Sensmeier, Manuel Garcia-Rulfo, Ethan Hawke, Denzel Washington, Chris Pratt and Byung-hun Lee star in Metro-Goldwyn-Mayer Pictures and Columbia Pictures’ THE MAGNIFICENT SEVEN.

Building a strong team is an important aspect of any healthcare leadership role. Companies and even projects often fail because they don’t have the right mix of people in place. However, when the right talent does come together, truly magical things can happen – whether that is transforming a culture, introducing a new product or disrupting an entire industry.

The film The Magnificent 7, which opens in theaters later this month, can teach us a few things about healthcare recruiting. Hired to protect a small village from a band of outlaws, one man must recruit a team to help him execute his task. Without spoiling the movie, below are 7 tips for recruiting your Magnificent 7: Read more »


4 Ways to Prepare for Increased CMS Oversight in the wake of Secret Shopper Success

September 13th, 2016 | by Deb Mabari

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Good news for Medicare agents and brokers: The Centers for Medicare and Medicaid Services (CMS) recently reported that of the 1,320 marketing events secretly shopped during the 2014 contract year Annual Enrollment Period (AEP), 85.5% were fully compliant.

This is a huge improvement from previous years, when CMS found more than half of secretly shopped events in violation of marketing guidelines. This data suggests that the program has been successful in reducing misconduct among health plans. However, don’t start celebrating just yet.

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Are you prepared for a CMS audit?

August 23rd, 2016 | by Tonya Teschendorf

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If The Centers for Medicare and Medicaid Services (CMS) walked through your door today and asked to audit your health plan, would you be prepared? Unfortunately, for many Medicare Advantage and prescription drug plans, the answer is “no.” Yet, with CMS continuing to crack down on compliance violations, this hypothetical audit could very well become a reality.

With Annual Enrollment Period (AEP) material preparations now in the critical final stages, the timing of these audits could be particularly bad for health plans that are not prepared. To manage the audit, they would need to pull crucial resources from compliance departments, increasing the risk of falling behind on AEP materials. This could delay distribution of important member materials, putting your plan at risk of incurring additional compliance violations and hefty fines.

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