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MedHOK Strategic Insights Blog

2017 Program Audit Results Show Continued CMS Enforcement Regime and Rigor

A few blogs ago we told you about major Centers for Medicare and Medicaid Services (CMS) Civil Monetary Penalty (CMP) activity in 2017. Recently, CMS released its annual Program Audit Report for the prior year and, as we told you then, it shows enforcement and rigor are not slowing down.

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Medicare Drug Changes in Store

The Secretary of Health and Human Services (HHS), Alex Azar, indicated recently that major changes in how drugs are administered in Medicare may come soon. The Centers for Medicare and Medicaid Services (CMS) has been increasingly concerned about the high-cost of pharmaceuticals in the program. While drug inflation has tempered, both Part B and Part D drugs are viewed as a major threat to the sustainability of the program over time.

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The Case For Universal Health Coverage

In the past, this blog has made the case that universal health coverage means not only a healthier nation but one that is far more prosperous and growth-oriented. The Economist magazine, this blogger’s favorite magazine for almost 40 years now, has again made an extremely compelling case for coverage for all. Included here are the links to their Leaders opinion piece entitled, “Universal healthcare, worldwide, is within reach,” as well as an abbreviated web version of their 10-page Special...

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Major Reporting and Universe Changes Again From CMS

Our blog has been ripe with information lately regarding Centers for Medicare and Medicaid Services (CMS) Civil Monetary Penalties (CMPs), Program Audit Findings, as well as, the focus on Independent Review Entity (IRE) Auto-Forwards. The compliance regime and changes are not slowing as is evidenced by the proposal from CMS to significantly overhaul universe submission formats, changes in audit protocols and major changes to annual reports. All this comes on top of major changes and...

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IRE Auto-Forward Sanctions Robust Over Past Several Years

As a follow-up to our recent blog on 2017 Civil Monetary Penalties (CMPs), we thought it would be important to review Independent Review Entity auto-forward findings by the Centers for Medicare and Medicaid Services (CMS) the past several years. After all, this is one of the hottest topics at CMS right now.

Because every audit is not published, we mined the CMS CMP website and analyzed every CMP related to a Program Audit conducted from 2014 through 2017, as well as independent CMPs levied...

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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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