Friday, January 7, 2011

Mandated Member Communications: A Case Study

At the end of 2010, we discussed in abstract the resource-draining, time-consuming process that is the preparation, distributing and reporting of CMS mandated member communications, highlighting how the enactment of the Affordable Care Act and tightening regulatory guidelines have only compounded this already trying process and how the penalties for non-compliance include monitoring, fines, and the risk of contract non-renewal.

We wanted to start 2011 off with a scenario, and while this is a true case study, we believe that there are aspects of this specific issue that are relatable to a number of organizations that are part of the healthcare marketing space:


A nationally-known insurance company was having difficulty managing the creation and distribution of mandated letters for their Medicare members. They lacked an in-house solution and their current production vendors could not manage the growing volume, facilitate mass template changes nor provide adequate reporting. This resulted in inaccurate mailings, missed deadlines, and poor CMS audit results. 

Additionally, the organization realized that in an effort to improve their CMS Five-STAR Rating, they needed to reduce the amount of appeals and grievances filed with CMS as a result of non-compliant communications.

Next week, we will discuss the solution that was developed that helped both reduce costs and improve workflow.


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

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