The policy analysis and guidance you need by the experts you trust, daily.
- After Hours
- Agent Oversight
- Brain Food
- Health Insurance Exchanges
- Part D
- Performance Optimization
- Policy & Health Reform
- Prospective Evaluations
- Provider Relations
- Risk Adjustment
- Sales & Marketing
- Star Ratings
- Alan Mittermaier on MA and Part D Proposed Rule Increases Plan Flexibility, Reduces Regulatory Burden
- Sharon Willliams on A New Source of Capital for Star Ratings and Clinical Innovations
- William on Will Trump and Price Pull Out the Scalpels for Star Ratings?
- Bobby on January Release of the Draft MMG – Perfect Timing
- Pam Lassila on Best Practices and Common Conditions of Audit Preparation
Every few months the industry hears news of new players getting into the Medicare Advantage (MA) game. And why not? According to the Kaiser Family Foundation, more than 19 million Medicare beneficiaries are enrolled in MA plans this year. Either someone is building from the ground up or purchasing an existing structure, such as CVS Health Corporation’s recent agreement to acquire Aetna. I don’t expect this will be the last pharmacy benefit manager to look for an insurer partner with the promise of being able to lower healthcare costs. While analysts argue over the benefits and concerns, one thing is for certain: you need experienced administrators at the helm. I borrow from the late Mitch Hedberg who summarized just because you can do something really well in one field doesn’t make you an expert in everything:
No, the Reagan administration hasn’t come back, but things are looking up in our corner of the world. The Centers for Medicare & Medicaid Services (CMS) is a big ship, and it takes awhile to turn it around after a presidential transition. It is becoming clear the direction will continue to be towards value, but the path is shifting. The government needs to reduce the spend on healthcare, and reducing benefits and restricting eligibility aren’t going to fly on the Medicare side, so we have to get more bang for the buck.
It’s the Annual Election Period (AEP) for Medicare Advantage (MA), and like many health plans, those of us in the industry are often busy. Family members on Medicare are often asking about changes or concerns about their health plan. When I checked in with my father, he indicated he needed to change his MA plan because he owed a $36,000 hospital bill he felt should be covered by his health plan. I thought he was confused until I saw his Explanation of Benefits (EOB), and it did have a $36,000 denial for a hospitalization. The denial message indicated, “You may owe this amount. You will be billed by your provider.”
Do it now! Get your benefit strawman, enrollment projections, and financial goals developed before benefit season begins!
Friends of mine built a house. They indicated it was the most stressful event, full of decisions they didn’t know they needed to make, and struggled to agree. The timeline they hoped for was not reality and had to be reworked. While they said they were stronger having gone through the process and they love their house now, it wasn’t the fun event they thought it would be, and they never want to build a house again.
The Centers for Medicare & Medicaid Services (CMS) Annual Call Letter calendar marks November 13, 2017, as the first due date for the Notice of Intent to Apply. It is expected the Center for Medicare will release a reminder memo this month outlining the details. In general, the agency requires a Notice of Intent to Apply to be submitted when an organization plans on submitting a request for any of the following: Read more
The 2018 “landscape files” for Medicare Advantage (MA) and Medicare Part D from The Centers for Medicare & Medicaid Services (CMS) are out, and they show the two programs as stronger than ever, and providing great value to beneficiaries. A closer look at the numbers also reveals the strategies of market leaders to get in front of two seismic events in government health programs.