On August 30, the Centers for Medicare & Medicaid Services (CMS) sent a letter to all 50 states, requiring a review of their eligibility systems. The impetus for this letter: CMS determined some states’ Medicaid and CHIP eligibility systems are incorrectly configured to automatically renew people at the family level and not the individual level. Read here how this requirement and recommendations affect health plan partners.
On August 15, 2023, CMS released the updated guidance for Part C and Part D enrollment and eligibility. Included with the policy and technical changes was a new MA model enrollment request form. Read about the notable updates here, as well as access links to enrollment/disenrollment instructions and forms.
Annually, open enrollment activities are a true performance test of your company’s systems and processes. Challenges faced during open enrollment can lead to significant compliance risks for your organization as it enters the CMS 2023 Program Audit time of year.
From 2022 to 2023, star ratings for Medicare Advantage Plans (MAPs) have dropped—from 68 percent of MAPs having 4 stars or higher to only 51 percent having 4 stars or higher. That means slightly less than half the plans available to Medicare eligible members have achieved a good rating. For those MAPs with lower CMS star ratings than they would like, or those with CMS star ratings they would like to maintain or boost, here are four tips for setting your organization apart and helping increase your CMS star rating.
Annually, open enrollment activities are a true performance test of your company’s systems and processes. Challenges faced during open enrollment can lead to significant compliance risks for your organization as it enters the CMS 2023 Program Audit time of year.
“A good intention with a bad approach often leads to a poor result,” says Thomas Edison. We agree, and this video of a baby elephant not being willing to leave the side of its mud-stuck mother is a great example. Not only does the baby elephant keep getting stuck itself, it also gets in the way of the workers who are trying to free its mother. The lesson: sometimes we can all use a little help.
As quick as one year passes and an open enrollment period closes, the next is upon us. To ensure customer expectations are met and compliance changes incorporated, here are five questions health carriers should ask as they future plan.
Carl Blanchette is a respected Independent Verification & Validation leader. After 30 years contributing to programs, primarily in health and human services, with a specialization in child support systems, he has learned many IVV lessons. Here are his top five.
One in five American adults are caregivers. More than a quarter of them struggle with coordination and just under a quarter of them (23 percent) say being in the service of others is bad for their health. New technology platforms make caregiver support easier by helping people do more with less.
Over the last decade, enrollment in Medicare Advantage has more than doubled. For health plans and the healthcare BPOs that often support them, this represents tremendous opportunity—provided they can navigate the demanding regulations. With the Annual Election Period (AEP) rapidly approaching (running October 15 to December 7th), here are six items Medicare Advantage Plans and BPOs must ensure are complete within the CMS regulatory timeframes.
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