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MedHOK Strategic Insights Blog

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

IMPORTANT REMINDERS

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

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 Alphabet Soup – Medicare HICN to Become MBI

After we just got over the implementation of ICD-10, health plans and providers are being asked to go through another major system conversion, this time to replace the Medicare Health Insurance Claim Number (HICN) with a new Medicare Beneficiary identifier (MBI).

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Of Healthcare Punditry and Crystal Balls: Anniversary Edition – Part 2

Last week, we bragged about our incredible success at predicting what would happen in the 2016 healthcare arena. We admitted that our clairvoyance was perhaps not as exceptional as one might think given some of the obvious predictions made. Nonetheless, we took high marks. Now, it’s time to sit down and stare into the crystal ball to tell you what we see happening in 2017.

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Of Healthcare Punditry and Crystal Balls: First Anniversary Edition – Part 1

 With this first edition review of our annual prognostications, we boldly say that our best guesses about what would happen in 2016 may rival Nostradamus’ prophecies (with a few misses) – although we admit the Frenchman had to be clairvoyant into future centuries! Below, we summarize what we said would occur in 2016 with our self-evaluated (and, perhaps, highly inflated) grades.

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Where, Oh Where, Will Our Healthcare System Go?

With President-elect Donald Trump's inauguration now about a month away, we can expect a flurry of activity surrounding Obamacare and the potential remake of both the Medicare and Medicaid systems. As we stated in our last blog, we believe a vigorous debate on all of our healthcare entitlements is not a bad thing at all. The alternative is lawmakers burying their heads in the sand as they have these past many decades and having the healthcare system continue down its dysfunctional road –...

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What Will Trump Healthcare Policy Look Like?

President-elect Donald J. Trump has named many key Cabinet positions over the last few weeks. Two words can describe many of his picks – “anti-establishment” and “transformational.” Past Presidents, Democrats and Republicans, have largely picked individuals that seemed to toe the establishment line, but Trump’s picks seem to strike a very different chord in Washington, D.C. 

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