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MedHOK Strategic Insights Blog

AHCA DEBACLE: Healthcare Repeal and Replace Train Derails

For old-time comedy TV aficionados, after the House leadership’s repeal and replace debacle this week, it was hard not to think of two I Love Lucy episodes. In the first, Lucy and Ethel were selling Aunt Martha’s Old Fashioned Salad Dressing. Despite all the fanfare over prospects for huge sales and success, the girls came to the laughable conclusion that they were selling a product for less than it actually cost to produce and they were going to “make it up in volume.” In the second...

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Time Out! Don’t Make Healthcare A Political Football

In his impassioned push to get conservative Republicans in line to vote for the House’s bill to repeal and replace Obamacare, Speaker Paul Ryan declared last week that “this is the closest we will ever get to repealing and replacing Obamacare.” If so, it is a sad reflection on the state of American governance these days for the proposal looks to be more of a political statement than a complete policy document and solution.

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Civil Monetary Penalties Continue at CMS for Medicare Advantage Plans

On March 1, 2017, the Centers for Medicare and Medicaid Services (CMS) released their list of plan audit results for Part C and Part D Sponsor violations found during the 2016 Program Audit. CMS also posted a series of Civil Monetary Penalty (CMP) letters on its website. MedHOK Strategic Insights has reviewed the findings and three things are clear: 

  1. CMS continues to demand strict compliance from Medicare Advantage (MA) and Part D plans and is not afraid to impose fines against them....

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Will Common Sense Prevail In Repeal and Replace?

Last week, we told you about the emerging House GOP plan to repeal and replace Obamacare. True to the fast-paced world of President Trump's administration, more details have come out over the past several days.

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Yodelayheehoo … Obamacare Repeal and Replace Taking Shape

About one month into President Trump’s administration, the strategy to repeal and replace Obamacare is beginning to take shape. This past week, newly sworn-in Secretary of Health and Human Services (HHS), Tom Price, and the House GOP met to discuss a timeline and parameters to repeal and the House unveiled a semblance of a plan to succeed the Affordable Care Act (ACA).

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2018 Call Letter Rather Humdrum; But No Signals Away From Value-Based Purchasing

Perhaps due to the new administration taking office just a few days earlier and the uncertainty surrounding health policy, the Centers for Medicare and Medicaid Services (CMS) released a rather humdrum Advance Notice of Methodological Changes for Calendar Year (CY) 2018 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2018 Call Letter on February 1, 2017. At the same time, it is important to note the document does not signal any retreat from the...

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January 2017 Compliance Insights


2017 Part C and Part D Call Center Monitoring

For 2017, CMS has contracted with IMPAQ International, LLC, to monitor Part C, Part D and Medicare-Medicaid (MMP) plan sponsors’ call centers to ensure compliance with two studies: The Timeliness Study and the Accuracy and Accessibility Study. The Timeliness Study measures current call center phone lines and pharmacy technical help desk to determine the average hold time and disconnect rates. An organization must maintain an...

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Healthcare Ructions Abound

The New Administration Takes Shape

As promised, President Trump has come out swinging in the first week of his presidency. Already, he has put the wheels in motion to repeal Obamacare and radically change healthcare programs.

Trump’s first executive order was aimed squarely at the Affordable Care Act (ACA). It instructed agencies to “waive, defer, grant exemptions from or delay” any part of the law that imposes a financial or regulatory burden on those affected by the law.

The practical...

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Does PhRMA Have More to Fear Under Trump Than Clinton?

Former President George W. Bush was famous for measuring every word he said in public for fear of spooking corporations, industries, and the economy as a whole. If the meticulous approach spawned some criticism and fodder for late-night comedians, Donald Trump’s approach appears quite the opposite (save for the late-night show antics). This past week, the President-elect sent the pharmaceutical industry’s stock prices into a nose dive when he stated at a press conference that PhRMA is...

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CMS Audit Season Is Upon Us

Now that the holidays are over and the calendar flipped to 2017, many health executives are waiting nervously to hear whether their plan will be among the “lucky few” to undergo a Medicare program audit by the Centers for Medicare and Medicaid Services (CMS) this year. With Civil Monetary Penalties (CMPs) and suspension of enrollment and marketing at record levels these past few years, the stakes for health plan revenue and survival has never been higher. 

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