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MedHOK Strategic Insights Blog

2017 CMPs Issued by CMS

The Centers for Medicare and Medicaid Services (CMS) recently posted Civil Monetary Penalties (CMPs) for 2017 and the trend toward rigorous compliance enforcement continues. 

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A Few Changes Between the Final Call Letter and the January Proposal

The release of the final Centers for Medicare and Medicaid Services (CMS) 2019 Call Letter for Medicare Advantage and Part D revealed a few significant changes from the draft of the February Call Letter previously released. In this blog, we focus only on the significant changes identified between the previous draft and the proposed final. Read the original blog on the draft letter here

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CMS Clarifies MBI Directions This Week

MedHOK has been in communication with the Centers for Medicare and Medicaid Services (CMS) as well as a number of health plan clients who have assisted us in clarifying some ambiguity surrounding the rollout of the Medicare Beneficiary Identifier (MBI) beginning April 1, 2018.

As we advised in mid-February and early March 2018, CMS issued two Health Plan Management System (HPMS) memos that indicated the following:

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Get Ready For Medicaid Compliance Regime

Long frustrated with the lack of quality in the Medicaid program and poor compliance records of states and plans alike, the Obama administration launched an initiative to overhaul and modernize Medicaid. The so-called Medicaid “mega” or “Uber” rule was finalized in his last year as he was heading out of office. When Donald Trump was elected, it was believed that this rule would go by the wayside.

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CMS Throws Last-Minute Curve Ball on MBI Migration

Health plans have been busy changing internal systems to plan for the arrival of the first Medicare Beneficiary Identifier (MBI) numbers on April 1, 2018. In an effort to reduce fraud and stolen identities in the Medicare beneficiary population, the Centers for Medicare and Medicaid Services (CMS) will begin issuing an MBI to those newly eligible for Medicare beginning April 1, 2018. Between April 1, 2018 and December 31, 2019 (the transition period), existing beneficiaries will be issued...

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HHS Secretary Endorses Value-Based Healthcare Transformation

When Donald Trump took office as President in January 2017, many (including this blogger nonetheless) predicted the end of (at least the intense threat to) a quiet transformation to value-based care. There was the following:

  • The intense dislike for government healthcare program expansions in general.
  • The attack on anything Obamacare.
  • The push by the GOP House to “reform” Medicaid by stripping it of the entitlement as well as applying a growth factor to the remake that would have spelled...

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Two Changes Will Have a Major Impact on Medicare Advantage and Part D

Reforms on the horizon mean big changes to financing and service delivery.

If adopted, Medicare Advantage and Part D plans will see two reforms happen on the near-term horizon that will mean major changes to financing and service delivery:

- Overhaul of aspects of Part D retail drug delivery

- Greater flexibility in benefits and services

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2019 CMS Call Letter Is Treasure Trove of New Polices

Due to recent mandate by Congress, the Centers for Medicare and Medicaid Services (CMS) is releasing the Advance Notice of Methodological Changes for Calendar Year (CY) 2019 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2019 Call Letter in two draft notices. The first came in late December and the second in early February. Click Here to review the official release for both Call Letters.

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The Three Wise Men (Warren, Jeff and Jamie) To The Rescue?

Large healthcare plans and other health-related stocks took a tumble last week on word that three very powerful men may be planning to transform the future of healthcare. Visionaries Warren Buffet of Berkshire Hathaway, Jeff Bezos of Amazon, and Jamie Dimon of JP Morgan Chase announced that they are creating an independent company focused on improving employee satisfaction and reducing healthcare costs for their respective companies and employees.

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Provider Network Review: The Next Great Compliance Bogey

Another compliance headache hits plans! The Centers for Medicare and Medicaid Services (CMS) completed its second round of Medicare Advantage (MA) online provider directory reviews between September 2016 and August 2017. The review looked at the accuracy of 108 providers and their locations selected in 64 MA plans’ directories (about 1/3 of MA plans, 6,841 providers, and 14,869 locations). 

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