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MedHOK Strategic Insights Blog

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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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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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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Risk Adjustment Changes Outlined In Additional 2019 Advanced Call Letter

While the Medicare Advantage and Part D Advance Notice Call Letter is usually done early each calendar year, plan actuaries and finance executives were treated to a late December additional notice a few days ago. The notice was triggered by the 21st Century Cures Act and directed the Centers for Medicare and Medicaid Services (CMS) to make several changes to the Hierarchical Condition Categories (HCC) Risk Adjustment Model used in the Medicare Advantage program.

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Final Medicare Advantage and Part D Call Letter Brings Few Surprises

On April 3, 2017, the Centers for Medicare and Medicaid Services (CMS) released the Announcement of Calendar Year (CY) 2018 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies, Final Call Letter and Request for Information. The final 2018 Medicare Advantage and Part D Call Letter brought few surprises. As we noted in our initial blog on the Draft Call Letter, CMS was not making radical changes to the course set in prior years -- with a few exceptions.

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March 2017 Compliance Insights

IMPORTANT REMINDERS

2017 MA & PDP Spring Conference & Webcast will be held on Wednesday, May 10, 2017 from 9:30 AM – 4:30 PM EDT. Register here.

The PDP Audit & Enforcement Conference & Webcast event will be held on Thursday, May 11, 2017 from 9:30 AM – 4:30 PM EDTIn-person registration closes Monday, April 24, 2017 at6pm EST. Register here.

2017 Data Validation Training for Contractors is now available.  Registration Information: Go to the MLN Learning Management System (LMS)  click on...

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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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