In years past, the norm for CMS has always been to conduct retrospective audits – essentially a review of data from prior months’ (EX. CMS would arrive at the plan in October to review data from January through June).
Audits were primarily focused their efforts on universe pulls and standard operating procedures along with any known escalated events that came through their jurisdiction such as CTMs.
Moving forward CMS will be conducting audits of plans on a more "real time" basis. They are conducting more "focused" audits and they are keeping a tight view of all plan CTMs and their occurrences.
Also, MA plans are now directed to report more in-depth information to CMS beginning with HEDIS and other metrics. With this increased scrutiny of plans and Medicare Improvements for Patients and Providers Act's arrival in 2008, the theme of tighter monitoring continues to resonate throughout regulation for 2010.
As such, better procedures and business processes are no longer discussion points, but key elements in maintaining quality and compliance (see: The 2010 Call Letter, Marketing Guidelines, and Enrollment and Dis-enrollment Guidance).
As with any guidance and changes from CMS, the first step is indentifying what’s new, then moving forward with an analysis of how it will change your business; what it could add, change or remove for your processes.
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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.
Wednesday, September 23, 2009
Wednesday, September 16, 2009
Are You Ready? Updates From AHIP Conference
With Annual Enrollment (AEP) soon to be here are you ready?
As with prior years, CMS has issued an extensive readiness check list for plans to follow and guide them in preparation of the upcoming 2010 plan year.
This year, with the multiple changes in regulation and continued scrutiny of marketing activities (see early post blog post from today), it is apparent there is much to do to ensure readiness on all fronts.
CMS recommends plans self-audit so there are no surprises.
While CMS has not provided the timeline for reporting readiness, as always, the sooner you begin the more confident you will feel.
Support materials are from CMS available for download here.
Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.
2010 Marketing Guidelines Could Improve Communications
With the recently released 2010 CMS Marketing Guidelines, and the current AHIP conference, here’s one of guidelines that caught my eye:
All plan sponsors that mail information to Medicare beneficiaries, prospective or enrolled, should include one of the three statements on any envelope or the mailing itself (if no envelope is being sent) that they are sending to Medicare beneficiaries regardless of the materials inside of the envelope. One of the three statements on the outside of the envelope or mailing itself should best fit the information being sent to the Medicare beneficiary which are:
1. Advertising pieces – "This is an advertisement;"
2. Plan information – "Important plan information about your enrollment; and
3. Health – "Health or wellness or prevention information."
On the surface, this sounds like an increase in cost. We’re confident that some planning can avoid that, and perhaps even create a way to reduce costs in the overall mailing piece, or improve the overall communication with prospects and enrollees.
I’m looking forward to continuing to discuss this and other CMS rulings throughout the week.
Note: The specific part of the guidelines referenced is section 50.6 - Plan Sponsor Mailing Statements on Envelopes/Mailing Itself.Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.
Thursday, September 10, 2009
Insurance Provider Shows the Way: Simple TIPS for Getting Started on Twitter
An industry leading insurance provider recently launched out into the Twitter world with their (here’s an article with more information: from the Cleveland Plain Dealer).
It’s inspiring to see Healthcare providers taking this step to better address customers needs, first by listening to what they are saying and then by responding and providing a gateway to answers, wherever those customers are seeking help.
Everyday people ask for advice on how to use Twitter - and sometimes even why they should bother.
The Why is easy:
- Twitter is a viable business information, interaction and customer service micro-blogging tool.
- You can gain access to a tremendous amount of information on Twitter.
- More and more companies will offer the Twitter option for Customer Service.
If that's not enough, some experts say there probably will come a time when a Twitter address is as common as email.
As with anything, getting started is hard.
Here are some tips that may help:
- Listen to the conversations that are taking place. Use keyword search (#yourname here) to identify what’s being said.
- Don't expect too much too soon. It takes time. And you will often hear from those with problems moreso than those that like what you do.
- Use the search tool to find topics of interest to you and people that follow you.
- Say something of interest ... join the conversation.
- Tell people you are on Twitter ... add it to your signature line on email.
- Stick with it.
Twitter is a simple tool that enables better communication on all sorts of topics. It’s also your chance to better serve customers.
Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.
Wednesday, September 2, 2009
Improving Results, Everyday
Improving results, everyday. It's a pretty straight-forward goal.
As a member of the Merrill Corp. team, I've worked with customers both large and small in interpreting Healthcare and Insurance regulations, meeting CMS requirements and improving processes to make compliance a simple part of the process and not a "trip to the dentist" (nothing against dentists', mine is quite good!).
In this blog, I'll be talking about just those things. And hopefully providing a few good insights and things to consider along the way.
I'll hope you'll join me in discussing CMS Compliance, Healthcare and Insurance regulations, and meeting and improving operating goals. It's not exactly a movie review, but it does impact companies, their customers, and you everyday.
Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.
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