Wednesday, January 12, 2011

Mandated Member Communications: A Case Study (Part 2)

Last week, we presented a scenario that, while specific in nature, has commonalities to what a number of organizations in the healthcare communications space may have to deal with when confronted with.the resource-draining, time-consuming process that is the preparation, distributing and reporting of CMS mandated member communications.

A nationally-known insurance company lacked in-house capabilities for managing the creation and distribution of mandated letters for their Medicare members. This resulted in inaccurate mailings, missed deadlines, and poor CMS audit results.


A web-enabled solution was created that systematically worked with the organization's data and married it to the correct CMS-approved template. The final document was then printed and distributed in one automated process.

This solution provided a chain of custody workflow that was desired by the organization and adhered to all CMS Chapter Two requirements and regulations. Furthermore, the built-in quality assurance processes validated the quality attributes of the letters and delivered 100% integrity management through the utilization of a 2-D bar code driven production process. Additionally, robust tracking – from file creation to delivery point validation, provided detailed, on-demand reports in response to any audit requirements.

This solution effectively transitioned a resource-draining, error-prone process
into a highly efficient, automated data management system. Utilizing HIPAA/PHI
compliant workflows and SAS 70 certified production and mailing facilities, the organization achieved 100% accuracy on all letters managed through this solution. Advanced SLAs provided same day delivery on all files received by 4 a.m., and overall program efficiencies delivered an immediate 20% cost reduction. Additionally, the organization leveraged proactive monitoring of regulatory changes to remain in compliance, at no effort to them.


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. Pam can be contacted at

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