Revenue Management
Success begins with enrollment operations.
Depending on your particular market, your MA plan can expect a reduction in payment in the neighborhood of 15% over the coming years. A hard job just got harder.
Continuing administrative revisions to the program mean that payment dollars are not only tighter---- they are much harder to realize. Added to these challenges on the Part C side is the complexity of the Medicare Part D payment structure. If not managed properly, these moving pieces can spell financial disaster for many plans that may otherwise be hitting their marks.
The healthiest plans have an integrated revenue management function, a cycle that begins on the front end with active member management and cycles through a robust revenue management function that spans departments and traditional operational silos. From Medicare Hierarchical Condition Category (HCC) management to Part C and Part D membership/enrollment data and Prescription Drug Event (PDE) reconciliation – we offer a full range of solutions to help you get the top line right so that you can turn your attention to managing to a robust bottom line.
Prescription Drug Event (PDE) Reconciliation
Due to the complexity of Part D, health plan Pharmacy Management/PBM operations, IT, Enrollment, and Finance must work together to achieve successful PDE processing.
PBM Pricing Audit
Ensure correct pricing for Part D claims. CMS requires MA-PD and PDP plans to maintain ongoing monitoring of their Medicare Part D programs. This includes a thorough understanding of the performance of the subcontracted PBM and utilization activity.
