The Plan Benefit Package (PBP) Module® is the latest CodySoft® tool that will revolutionize the way health plans manage plan benefit and related data. The module allows plans to import data from multiple sources, including directly from the HPMS PBP tool via PBP xml Reports, into one centralized location.
The data can later be exported as an enterprise-wide data grid to support contract tables, LIS tables, marketing tables, operational data and more, all from one centralized system. The best part about the Plan Benefit Package (PBP) Module® is it allows for tight version control and provides a centralized source of truth for all plan benefit information and more.
“PBP information comes into a health plan in different formats from the state, federal government and various contracts — and nothing is consistent,” said CODY CEO Deb Mabari. “Our experience of over a decade working with health plan’s PBP data from across the country allows our team of document development experts to understand the challenges plans face and the intricacies of trying to manage this data. We developed the PBP Module to ingest data and transform it into member-facing text and a structured format that is usable enterprise-wide.”
How to Keep Your MA Staff’s Skillset Current in the Slow Season
The work of creating member documents for Medicare Advantage (MA) members is a highly seasonal endeavor. Typically, MA staff begin work on these documents in mid-April. Per Centers for Medicare and Medicaid Services (CMS), the Annual Notice of Change (ANOC) must be in members’ homes by September 30, and Evidence of Coverage (EOC) documents are due by October 15.
After that date, the intensity of the work effort on MA documents is considerably reduced and employees turn to other assignments. During this period, it’s a challenge to keep employees’ skill sets sharp and up-to-date. Read more »
PERSPECTIVES: Eliminate Cost Sharing from Insurance Plans
Cost sharing is the system by which health insurers charge members a portion of payments for health care services as copayment or coinsurance. For example, Medicare Part B covers only 80% of most medical service costs, and members are responsible for paying the remainder of the bill. This current cost-sharing system is needlessly complex and costly to administer. Why?
A more logical system would be that a member pays only the insurance premium and is either covered or not covered for benefits in an insurance plan. In other words, we should consider getting rid of cost sharing. Eliminate deductibles on the same principle. In a system based on plans without deductibles, coinsurance, or copayments, it would be much easier for members to understand their plan’s benefits. Bills would be less confusing, resulting in fewer calls to Member Services with billing questions. Additionally, members would be able to budget their household finances because their insurance bill would be a fixed amount, not one that has to be recalculated every time they access a benefit. For people on fixed incomes and others on tight budgets, this change would be very valuable.
PERSPECTIVES: How to Improve Communications with Health Plan Members
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?
4 ways to reduce – or eliminate – errors in your ANOCs and EOCs
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
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.
Dealing with Change in the Medicare World
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: