Blog

Posts Tagged: compliance

Can Outsourcing Your Member Marketing Materials Production Pay for Itself?

March 27th, 2018 | by Brad Boyer

Materials Creation, Print & FulfillmentTags: , , No Comments »

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?

Read more »


Posts Tagged: compliance

6 Traits of a Great Consulting Partner

February 19th, 2018 | by Deb Mabari

Compliance, Materials Creation, Print & FulfillmentTags: , , , , , , , , , No Comments »

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 »


Posts Tagged: compliance

Errors in ANOCs and EOCs could cost up to $55 per affected enrollee

August 14th, 2017 | by Kevin A. LeBlanc

Compliance, Materials CreationTags: , , , , , , , , No Comments »

Over the last several years, The Centers for Medicare and Medicaid Services (CMS) has taken an increasingly tough stance on health plans that distribute Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) documents with unclear and/or inaccurate benefit information.

CMS is no longer sending health plans warnings for these errors; they are imposing civil money penalties (CMPs) for thousands of dollars that health plans must pay. For instance, CMS recently imposed a CMP in the amount of $132,000 to a health plan for failing to provide accurate benefit information to 2,400 enrollees in its Contract Year (CY) 2017 ANOC and EOC documents. For larger health plans, fines can quickly add up to millions of dollars.

CMS’s reasoning behind these fines is that if members receive inaccurate information related to premiums, deductibles and co-pays, they may enroll in a plan under false expectations. Read more »


Posts Tagged: compliance

3 Ways Growing Health Plans can Avoid Adding FTEs

November 29th, 2016 | by Kevin A. LeBlanc

UncategorizedTags: , , , No Comments »

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.

Read more »


Posts Tagged: compliance

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

September 13th, 2016 | by Deb Mabari

ComplianceTags: , , No Comments »

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.

Read more »


Posts Tagged: compliance

Are you prepared for a CMS audit?

August 23rd, 2016 | by Tonya Teschendorf

ComplianceTags: , No Comments »

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.

Read more »


Posts Tagged: compliance

Using Technology to Streamline Your Policies and Procedures

September 11th, 2015 | by Deb Mabari

UncategorizedTags: , No Comments »

Policies and procedures are an important part of health plans’ day-to-day operations. However, if these are not documented and managed properly – including being updated each year – health plans may be subject to costly fines and corrective action plans from the state.

Read more »


Posts Tagged: compliance

3 Ways Mismanaged Policies and Procedures can Cost you Money and Members

September 4th, 2015 | by Deb Mabari

UncategorizedTags: , No Comments »

Behind every health plan are a number of policies and procedures that serve as a framework for the organization and the care of its members. These policies include all aspects of operation, from payment and authorization to coordination of benefits.

Read more »


Posts Tagged: compliance

Choosing the Best IT Solution to Manage AEP Collateral Creation

June 29th, 2015 | by Brian Yavorsky

Print & FulfillmentTags: , , , No Comments »

A number of IT solutions have emerged over the last several years to help health plan marketing and compliance teams manage the materials creation process. These solutions range from costly enterprise installs to more affordable cloud-based applications, and offer any number of features to help plans navigate the AEP collateral creation season. Read more »


Posts Tagged: compliance

How Medicaid Plans can Prepare Compliance Efforts for Increased CMS Oversight

April 15th, 2014 | by Tonya Teschendorf

ComplianceTags: , , , , , , , No Comments »

The writing is on the wall. There are well-documented issues of a lack of uniformity and accountability surrounding state Medicaid programs. Understanding CMS’s history of recognizing problems and acting to find solutions, it stands to reason the agency will, in the future, establish compliance programs for state Medicaid plans that mirror those of Medicare.

When CMS establishes greater control and oversight of Medicaid at the state level, government-sponsored health plans will have a new set of issues to work through in order to comply with the new regulatory guidance. The good news is these new regulations will most certainly mirror those already in effect for Medicare. Therefore, mirroring best practices in Medicare compliance today will better position health plans in the future.

Read more »