Four Actions That Could Sabotage Your Member’s Experience

Julie Billman

It’s the Annual Election Period (AEP) for Medicare Advantage (MA), and like many health plans, those of us in the industry are often busy. Family members on Medicare are often asking about changes or concerns about their health plan. When I checked in with my father, he indicated he needed to change his MA plan because he owed a $36,000 hospital bill he felt should be covered by his health plan. I thought he was confused until I saw his Explanation of Benefits (EOB), and it did have a $36,000 denial for a hospitalization. The denial message indicated, “You may owe this amount. You will be billed by your provider.

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Pressure Test your 2019 Expansion Strategy in 3 Steps

Diane Hollie

Do it now! Get your benefit strawman, enrollment projections, and financial goals developed before benefit season begins!

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Benefit Administration Testing – From a Compliance, Audit, and Best Practice Perspective

Miru Monte

In 2016, 41 million individuals (72 percent of all Medicare beneficiaries) were enrolled in Medicare Part D. Of …

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Opioid Abuse: A Growing Compliance Risk for Medicare Advantage Plans

Debra Devereaux

Opioid overutilization and the corresponding public health crisis are ubiquitous in the daily news. In September 2017, the …

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As CMS Administrator Verma Announces Obama-Era Medicaid Policy Reversals, States Signal Support for Medicaid Expansion

Olga Walther

Tuesday was a big day for Medicaid policy, with both a rollback of Obama Era policy reversals and …

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The 2019 Proposed Notice of Benefit and Payment Parameters

Jessica Smith

The annual Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameter (NBPP) for 2019 …

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Influencing Your 2019 Star Ratings: Every Day Matters

Melissa Smith

With the recent release by the Centers for Medicare & Medicaid Services (CMS) of 2018 Star Ratings to …

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