Topic: Compliance

Three Costs of Marketing Material Errors

Regan Pennypacker

Now that bids have been submitted and the Centers for Medicare & Medicaid Services (CMS) is in the process of finalizing their posted models (check the dates on those versions, people!), it’s time to think about material development and review.

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The 2019 Model Marketing Materials Are Posted. Ready for What’s Next?

Regan Pennypacker

As we await the Medicare Communications and Marketing Guidelines (MCMG), The Centers for Medicare & Medicaid Services (CMS) released the 2019 Model Marketing Materials which includes standardized outreach and educational materials for Medicare Advantage Plans, Medicare Advantage Prescription Drug Plans, Prescription Drug Plans, and 1876 Cost Plans.

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CMS Audit Annual Report Highlights Importance of Mock Audits

Beth Matel

Imagine you are the Compliance Officer of your health plan, and you see the email from the Centers for Medicare & Medicaid Services (CMS) announcing you have been selected for a program audit. Did you take the opportunity in the months leading up to this day to confirm your organization can pull compliant universes? Did you take the time to perform some mock reviews with your Organization Determinations, Appeals, and Grievances (ODAG), Coverage Determinations, Appeals, and Grievances (CDAG), Formulary Administration (FA), Special Needs Plan Model of Care (SNP-MOC), if applicable, and Compliance Program Effectiveness (CPE) staff to ensure they are comfortable and skilled presenters? What about your first-tier, downstream, and related entities (FDRs)? Or did you wait, thinking you had plenty of time to get this done?

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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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Takeaways from the Gorman Health Group 2018 Client Forum

John Gorman

The Gorman Health Group 2018 Client Forum concluded last week in Las Vegas with over 300 of our closest clients and partners. As we enter our 22nd (!) year, we returned to the Red Rock Resort where a great time and shared learnings were had by all.

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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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Is it the End of the Medicare Marketing Guidelines as we Know Them?

Betsy Seals

For those of us who have worked for years in the marketing and sales arena, the release of the Centers for Medicare & Medicaid Services (CMS) memo, “Request for Input on the 2019 Medicare Communications and Marketing Guidelines,” on April 12, 2018, somehow felt like the end of an era. In this memo, CMS confirms the Medicare Marketing Guidelines (MMG) will be renamed the “Medicare Communication and Marketing Guidelines.”

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