Thursday, October 28, 2010

CMS Shares More Medicare Information.

This week, in our continue our assessment of CMS’s new health care regulations, we are examining some of the details of the ACA’s efforts to spread knowledge about Medicare.

The ACA has already launched the Medicare Plan Finder tool. This tool will allow beneficiaries and health plans to easily view information about their plans and benefits. The system already contains information about 2010 and 2011 data, with further updates to be conducted on October 28th. Among these updates will be the ability to search for information by plan name or identification number, making it even easier for beneficiaries to find what they need to know.

A detailed pamphlet, Medicare and You, is currently being mailed out to all Medicare recipients. The handbook will describe the details of various plans and benefits, and is intended to be used as an aid for individuals to determine whether or not moving their coverage would be beneficial. CMS stresses that any decisions about changing one’s coverage should be researched through a trusted source, such as 1-800-Medicare, or the official government websites. Employer group and Union Medicare recipients can find information at these sources as well.

Finally, CMS has stated the importance of holding on to any Medicare information or documents that they receive through the mail for the rest of this year, as many changes are likely to affect current beneficiaries. This is all part of CMS's attempts to reduce Medicare fraud and abuse.


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

Thursday, October 21, 2010

New ACA Regulations Prompt Medicare Policy Changes.

Performed mostly in an effort to update the industry on new ACA regulations, CMS has released a large amount of information on new policies. These changes to regulations are primarily related to the benefits that Medicare will offer in 2011.

Beginning January 1st, Medicare beneficiaries can expect to receive:
  • One annual physical examination at no cost.
  • Free Wellness visits.
  • New free health screenings.
  • A 50% discount on covered brand-name drugs and a 7% discount on covered generic drugs.
  • Protection from excessive cost increase, through aggressive bids.
  • Consolidation of low enrollment and duplicate plans.
  • Set limits on out-of-pocket expenses.
  • Coverage of preventative services with no cost sharing.
  • Limits on cost sharing for skilled nursing care, chemotherapy, and renal dialysis.
CMS’s other major release this week described a renewed attention to inform seniors about the fraud, waste, and abuse that have been associated with Medicare in the past. The initiative has already launched, and is centered on two hotlines set up by the federal government. Interested parties can find information either of these hotlines, or 1-800-MEDICARE, for information on spotting fraud, waste, and abuse of Medicare. Merrill Corp will continue to post information about further ACA-related changes over the coming weeks.

Sunday, October 17, 2010

Translating Healthcare

“, like, is an unprecedented website which provides consumers with the power of information at their fingertips. Individuals, families, and small businesses will be able to easily compare both public and private health coverage options tailored specifically for their needs, said HHS Secretary Kathleen Sebelius. “ will give Latinos across the nation better information about the choices they have, how much they cost, and what they can expect from their doctor--specific to their life situation and local community.”
While the six month anniversary of the Affordable Care Act was celebrated on September 23rd with a conclave of changes, ranging from a ban on insurance companies discriminating against kids with pre-existing conditions to young adults being able to stay on their parent’s health plan, for many, October 1st was the day they had been looking forward to the most.
The U.S. Department of Health and Human Services, to further their goal of improving the overall member experience, created a Spanish language version of the website, which can be found at (the page officially launched on September 8th, but October 1st was the date that essential cost data was uploaded). is the first website of its kind. Developed entirely in Spanish primarily, its mission is to help even more consumers take control of their healthcare by connecting them to new information and resources that will help them access quality, affordable health care coverage.

This is a necessary step in the goal of creating a healthier country because, according to HHS:
  • One in three Hispanics lacks healthcare coverage.
  • Half of all Hispanics do not have a regular doctor.
  • Hispanics suffer disproportionately from chronic health diseases such as diabetes and cardiovascular disease.
  • Hispanic women contract cervical cancer at twice the rate of white women.
Thinking beyond the politics of the healthcare issue, as a technology-enabled services provider for a wide range of industries, we commend the seriousness and accuracy HHS, as well as CMS and the DOIs have shown with translated pieces. The website is just one example, and comes on the heels the new requirement that all communications need to be available to prospects and members in areas in which 10% of the population have the same first language. We believe that these changes and enhancements will aid all the agencies in their goal of improving education and decreasing confusion for more people.

Friday, October 1, 2010

The Patient and Protection Affordable Care Act…..6 months later

While The Patient and Protection Affordable Care Act (ACA) was enacted on March 23, 2010, it didn’t officially go into effect until last week on September 23. However, despite being enacted, there are still many debates and discussions raging on about the bill.

The goal of the ACA was to reduce the cost of healthcare, improve the quality of care and improve the overall member experience. Thus ACA included the following items:
  • No lifetime or restricted annual limits on benefits
  • Eliminated pre-existing conditions and rescissions
  • Young adults covered to age 26 on their parent's policy
  • Drug discounts for seniors (starting June 15, 2010)
  • Tax break for small businesses
However, there are also additional changes taking place behind the scenes that many consumers are unaware of, but could greatly alter the healthcare landscape. Most notably, changes to Medicare Enrollment Period’s and Medical Loss Ratio calculations.

With reduced enrollment periods, plans will have to alter how and when they market to their members. This constricting timeline is going to make an already trying process, an even greater strain on resources. Additionally, the 80-85% Medical Loss Ratio that plans will be mandated to operate at will force some plans to change their plan type, or worse may force them to drop certain coverage in order to comply.

On top of all of this, with November elections looming, funding may be reduced or cut and each new member of Congress will push for what they think will be the best circumstance for their delegates. Like always, Merrill Corporation will be monitoring all these changes and more from HHS, CMS and all other regulatory bodies to ensure that health plans can successfully navigate and comply with Health Reform.