Tag Archives: Medicare Advantage

Azar Testified on Drug Pricing. Industry Yawns.

John Gorman

Health and Human Services (HHS) Secretary Alex Azar  was in front of the US Senate Health Committee for a hearing today on drug pricing. His prepared remarks freaked out the market open saying the US “fundamentally may need to move toward a system without drug rebates, where PBMs and drug companies just negotiate fixed-price contracts.”

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Group Retiree Medicare Advantage Products Are Poised to Explode in 2019

John Gorman
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2018 Audit & Enforcement Conference: Program Audit Changes on the Horizon

Regan Pennypacker

On Monday, I provided some highlights of last week’s conferences during our weekly Insider call. The Centers for Medicare & Medicaid Services (CMS) hosted the Spring Conference on May 9 and the Audit & Enforcement Conference on May 10. The Program Audit tools and methodology continue to evolve. The agency gave the industry a heads up about the changes when the data collection tools were posted for public comment. Today I focus on one session, New Approach to 2019 Audits and Universes.

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Could Medicare Advantage Be Facing More Legislative Reform This Year?

Olga Walther

The House Ways & Means Committee held a hearing Tuesday on the Medicare Advantage (MA) program. Lawmakers eagerly pointed out the success and bipartisan support for the program and were generally very receptive of the feedback received from the panel of experts. The panel included two plans – Clover Health and Independence Blue Cross of Philadelphia – and two policy researchers.

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Lack of Staff: Biggest Hurdle to Success

Regan Pennypacker

Staffing continues to be a major hurdle in the healthcare industry. A recent poll conducted by Gorman Health Group showed that 38% of respondents believed the biggest hurdle to success in their organization was lack of knowledgeable staff or lack of staff.

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Latest Audit Enforcement Actions Issued by CMS

Regan Pennypacker

Like clockwork, the Centers for Medicare & Medicaid Services published the enforcement action notices issued to sponsors related to 2017 program audits. Additional detail regarding conditions, audit scores, and enforcement is expected to be included in the 2017 Program Audit Enforcement Report, which the agency hopes to release before their conferences taking place May 9-10. In the meantime, we break down the published data, which includes not only program audit actions but others as well: Read more

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Four Common Operational Pitfalls in Medicare Advantage

Julie Billman

I live in the Northeast, and we are once again in the midst of a nor’easter. It is this time of year when I consider moving south. The only way to keep on top of this volume of snow removal is to regularly clear driveways and sidewalks. Some snow is a very heavy lift, and some is very light and easy to shovel—and so it is with working through some of our common Medicare Advantage (MA) operational issues. Our experiences with clients cover a wide range of projects: we complete operational assessments, financial reviews, operational trainings, and policy and procedure (P&P) reviews. Throughout our projects, we see some common themes that cause health plans to trip. Some take more effort to resolve, but some are light lifts.

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