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The Voice of Julie Billman
A few years ago I lived in Utah, which is an amazingly beautiful state. I visited Bryce Canyon and went horseback riding into the canyon. My horse’s name was Anaconda, and his size lived up to his name. I grew up around horses, but it had been decades since I was on one. The tour started, and it wasn’t very long before I thought I made a big mistake. I had a hard time staying centered on Anaconda, and the other horses were walking right on the edge of the cliff. To top it off, I’m afraid of heights.
Starting your Medicare Advantage Prescription drug (MA-PD) plan on the right foot and staying out of the non-compliant spotlight are two important goals for implementing your new plan. The 2018 MA-PD Application Cycle is coming to an end, and new health plans are moving through their first bid process. Ideally, your implementation is well underway, having started the end of 2016 for a January 1, 2018, effective date. Additionally, some organizations are now considering entries into MA-PD for a 2019 or 2020 start date. No matter which group you are part of, there are several key things which should be included in your work plan that are often not considered in your original implementation. Don’t worry – if they aren’t on your work plan yet, there is still time for 2018!
Things in Medicare are fast and furious. When you mix staffing and system changes to an already hectic environment, every program is steps away from non-compliance and process break-downs. Much of our operational efforts are working against the natural degradation that occurs in fast-paced departments. Without well-documented, consistent practices and excellent controls in place, how do you demonstrate day in and day out that you are compliant? Here are some questions you can ask your Operations departments to ensure critical components are functioning as expected: Read more
Open enrollment is over, and as we move through the first quarter of 2017, all kinds of problems bubble up to the surface ‒ cancelations that didn’t process are identified by frustrated members, questions on the Annual Notice of Changes not received or not read are talked through, members enrolled with doctors who are no longer in the network become calls of desperation as care is needed. Do any of these sound familiar?
Home repair becomes far more complex when something is out of square. Everything is more difficult, and work-arounds become standard. That is why a foundation stone is so important in construction – it is the first stone set, and all other stones will be built around it. Making sure it is in perfect alignment is critical. Implementing a Medicare Advantage (MA) or Prescription Drug Plan (PDP) requires the same precision. If you don’t start with things perfectly aligned, you will always be fighting a battle to keep things straight, compliant, and productive.
It’s that time of year again. The time of year we evaluate our lives and make decisions to improve things for the New Year. How do we start 2017 with more than good intentions? We should invest that same energy and vision into our work and operations teams. Let’s focus on what we can do to achieve our goals for 2017.
There are some surprises that are good, like winning the lottery or getting a promotion. There are other surprises that are not so good. These include things like a leaking roof or an unexpected bill. At the office, a negative surprise is someone finding out about a problem in your department before you do. It is even worse when it is identified by a Centers for Medicare & Medicaid Services (CMS) regulator.