Topic: Brain Food

CMS released proposed changes to payment rule for Durable Medical Equipment Prosthetics, Orthotics, and Supplies

David Sayen

In one episode of the Sopranos, Tony’s brother-in-law runs up a gambling debt with the mob.  Tony and his pals “bust out” the brother-in-law’s sporting goods store by taking out big loans and maxing out the lines of credit. The store closes, Carmela’s brother declares bankruptcy, and the mob keeps the money. It is feeling to me like a similar “bust out” is happening right now in Washington.

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Focus on Rural Population: What Your Plan Still Has Time to Do

Jane Scott

Here we are at the end of July already! Time flies, especially when we are busy preparing for enacting our bid submission approvals and planning for rollout of plan year 2019 activities and new members. It is not too late to still enhance this year’s activities and positively affect our members within the remaining five months of this plan year, especially in the rural areas of your plan’s service area. CMS released its first “rural health strategy” here: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2018-Press-releases-items/2018-05-08.html

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More Oversight Ahead for Medicaid Managed Care

Olga Walther

As the Medicaid program is wrapped up in the battle of expansion and work requirements, the Centers for Medicare & Medicaid Services (CMS) is quickly pushing along its efforts to increase oversight of the program as well, and Managed Care Organizations (MCOs) should be prepared.

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Prep for the 2019 Medicare Communications and Marketing Guidelines

Diane Hollie

I am shocked the 2019 Medicare Marketing Guidelines (MMG) did not come out last Friday since that is when I started vacation. But no… a week later, we are still waiting, and now the wait really starts to impact the development of our marketing strategies and tactics.

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Amazon: The Next Prescription for Healthcare?

David Sayen

Good Morning David, its 7 a.m.

 Good morning Alexa, what is on the calendar this morning?

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Insights for a Smooth RADV Season

Jessica Smith

Risk adjustment audit season is upon us. Some health plans are already in the thick of retrieving charts and starting reviews. Whether it’s a Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) audit or a Health and Human Services (HHS)-RADV, one thing is true: being prepared is a must!

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CMS Doubles Down on Member Experience

Melissa Smith

At Gorman Health Group, we have the privilege of collaborating with organizations across the full spectrum comprising our members’ experience – from health plans and providers to vendors and pharmacy benefit managers (PBMs) – and though almost every person I talk to in every type of organization strives to create excellent member experiences, many struggle to successfully do so. The Centers for Medicare & Medicaid Services (CMS) recent pledge to put patients first in all of their programs has changed the calculus of “the member experience” in Medicare Advantage (MA). We’ve heard these words for years, but this time it’s real.

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