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The Voice of Julie Billman
The Centers for Medicare & Medicaid Services (CMS) Advance Notice and Call Letter included additional reminders to plans about managing Qualified Medicare Beneficiaries (QMBs). A QMB is a dual-eligible beneficiary who does not have full Medicaid. Instead, that individual has Medicare cost-sharing subsidies by the state Medicaid program for Part A and B covered deductibles and coinsurances. When a QMB member is part of a Medicare Advantage (MA) plan, it becomes the MA plan’s responsibility to ensure providers do not balance bill the member for the plan deductibles and cost sharing for Medicare-covered services provided by the MA plan.
I fly often, and it gives me comfort knowing my pilot completes a pre-flight checklist. I often see the pilot out on the tarmac walking around the plane giving it a quick inspection. It is a demonstration he/she takes our safety seriously.
When you think of the ideal strategic partner, what words come to mind to describe them? For me, those terms are honesty, integrity, value-add, vision, and an understanding of my needs. These are the same things that members are expecting from us when they choose our health plan to provide their health insurance. As we start 2018, all of our staff have the opportunity to prove our commitment and demonstrate our health plan’s core values to enhance our members’ experiences. As you enter into 2018, here are some reminders of critical components to support your members in 2018. Read more
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.”
Friends of mine built a house. They indicated it was the most stressful event, full of decisions they didn’t know they needed to make, and struggled to agree. The timeline they hoped for was not reality and had to be reworked. While they said they were stronger having gone through the process and they love their house now, it wasn’t the fun event they thought it would be, and they never want to build a house again.
In 2017, the Centers for Medicare & Medicaid Services (CMS) moved from a Readiness Attestation to a Readiness Checklist with a Strategic Discussion with your Regional Office. A movement away from attestations may move some plans to take the process less seriously. CMS raises issues in the Readiness Checklist because they are either critical components or because they are areas of risk. It isn’t often in life we are handed a list we can use to double-check critical components are in place.
On Monday, the United States experienced the first full solar eclipse since 1979. In order to get the full impact of the eclipse, without causing vision damage, a certain type of glasses or an indirect viewing method was needed. It was an exciting event for those who took the time and had the opportunity to see it. In a small number of locations, it became totally dark for a few minutes and thus easily identified. In other locations, it was not visible without stepping outside to look for it with the right tools.