Tag Archives: CMS

Supplemental Benefits: New Rules and New Opportunity

Debra Devereaux

Two recent Centers for Medicare & Medicaid Services (CMS) Health Plan Management System (HPMS) memos clarified supplemental benefit parameters and the rules for uniform distribution of those benefits (“Reinterpretation of the Uniformity Requirement,” April 27, 2018, and “Reinterpretation of ‘Primarily Health Related’ for Supplemental Benefits,” April 27, 2018). Supplemental benefits were defined as “an item or service (1) not covered by Original Medicare, (2) that is primarily health related, and (3) for which the plan must incur a non-zero direct medical cost.” Of primary interest to health plans in the immediate future as bids are due June 4, 2018, are the following: Read more

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The 2019 Final Call Letter: Stability & No Unexpected Surprises in Star Ratings

Melissa Smith

The Centers for Medicare & Medicaid Services (CMS) Star Ratings updates in the 2019 Final Call Letter offer a true gift to Medicare Advantage (MA) plans. No significant changes were introduced from the changes previously announced in the Advance Notice, with the interesting surprise CMS still has not removed any of the “topped out” measures or made changes intended to support Administrator Verma’s Patients Over Paperwork or Meaningful Measures vision. Assuming no surprises are introduced when the technical notes are released, CMS provides MA plans with the gift of stability and no unexpected surprises in Star Ratings.

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2019 Medicare Advantage Rate Announcement & Call Letter

Celia Girard

On Monday, April 2, 2018, the Centers for Medicare & Medicaid Services (CMS) released the Announcement of Calendar Year (CY) 2019 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter.

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Audit Engagement Letters Will Start in March

Caron Wingerchuk

If you did not have the pleasure of being part of a Centers for Medicare & Medicaid Services (CMS) Program Audit in 2017, don’t be caught off guard if you receive your invitation this year.

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CMS Reports Medicare Advantage Provider Directories Continue to be Plagued with Inaccuracies

Elena Martin

The Centers for Medicare & Medicaid Services (CMS) issued its Round Two online provider directory review, and the results were dismal. Plans reviewed showed an overall inaccuracy average higher than Year One plans. We can try to marginalize the results and say the average inaccuracy found by location was 48%. Nevertheless, the fact remains that nearly half of all directory locations reviewed were inaccurate. Breaking it down further, the inaccuracies ranged from 11% to 97.82%. We are living in an age of tech-savvy consumerism. If our GPS or Google results proved incorrect half of the time, we would not be satisfied. If results proved correct less than 3% of the time, we would be outraged.

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CMS Releases Part II of the Medicare Advantage Advance Notice & Draft Call Letter

Olga Walther

On February 1, 2018, the Centers for Medicare & Medicaid Services (CMS) released its 2019 Advance Rate Notice (Part II) and Draft Call Letter. CMS estimates an expected increase of 1.84% to payments in 2019. CMS says its estimates do not reflect underlying coding trend, which it expects to increase risk scores by 3.1% in 2019.

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Second NOIA Deadline Approaching

Regan Pennypacker

Applicants looking to enter Medicare Advantage, Part D, or the Medicare-Medicaid Plan space have two deadlines to submit a Notice of Intent to Apply, commonly referred to as a “NOIA,” for contract year 2019: November 13, 2017, and January 26, 2018. The first submission allows the Centers for Medicare & Medicaid Services (CMS) team to gauge what resources might be needed during this critical time of year. The second date is provided to allow potential suitors to review the final 2019 application requirements, which should be released here, here, and here around January 9, and then make a decision.

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