CMS Announces New Marketing Regulations (Part 3)

CMS has approached the 2013 Marketing Regulations with a critical eye, and an editorial focus. In an effort to simplify and clarify the rules, CMS has removed around 70 pages from the document. Over the next few weeks, we’ll look at some of those changes, and explore what motivated CMS to make such drastic edits.

We've explained some of the motivation behind core rules in the CMS 2013 Marketing Regulations. This week, we'll take a look at some specific rules, and how they will impact your marketing materials in 2013.

First of all, CMS is requiring all plans to create a document called the Multi-Language Insert. This document must be included with the Summary of Benefits and the ANOC or EOC no later than September 30th, 2013. The Multi-Language Insert is a document that contains the following statement, printed in Spanish, Chinese, Tagalog, French, Vietnamese, German, Korean, Russian, Arabic, Italian, Portuguese, French Creole, Polish, Hindi, and Japanese.

“We have free interpreter services to answer any questions you may have about our health or drug plan. To get an interpreter, just call us at [1-xxx-xxx-xxxx]. Someone who speaks [language] can help you. This is a free service.”

This statement cannot be modified, other than to include additional languages.

In addition to the Multi-Language Document, there are also materials that are required to be included with any electronic or printed enrollment form. These include

• A Plan's CMS STAR Ratings Information
• Summary of Benefits

New or renewing members at enrollment and thereafter must receive

• Annual Notice of Change /Evidence of Coverage (ANOC/EOC) or EOC as applicable
• Multi-Language Insert
• Comprehensive formulary or abridged formulary (Part D sponsors only)
• Pharmacy directory (For all plan sponsors offering a Part D benefit, this is required at time of enrollment)
• Provider directory (For all plan types except PDPs, this is required at time of enrollment)
• Membership Identification Card (required only at time of enrollment and as needed or required by plan sponsor post enrollment)

Too much to take in? Don't worry, we'll be wrapping up next week by revisiting some of the guideline rules that carried over from previous years.

-------------------------------------------------------------------------------------------

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.

 

CMS Announces New Marketing Regulations (Part 2)

CMS has approached the 2013 Marketing Regulations with a critical eye, and an editorial focus. In an effort to simplify and clarify the rules, CMS has removed around 70 pages from the document. Over the next few weeks, we’ll look at some of those changes, and explore what motivated CMS to make such drastic edits.

Last week, we introduced some of the basic concepts behind the latest version of CMS’ marketing regulations. Today, we’ll finish explaining the last two of three guiding principles that served as the basis for the document.

CMS clearly states plan sponsors are responsible for full disclosure when collecting and disseminating information to beneficiaries about plan benefits, policies, and procedures.

 This rule simply lays out transparency and responsibility for plan marketing and beneficiary information. For example, beneficiaries must be provided enough information to make an informed decision about health plans. In addition, plan sponsors must use sound judgment in all aspects regarding the beneficiaries and their delegated entities.

CMS states plan sponsors are responsible for documenting compliance with all applicable Medicare Marketing Guideline Requirements.

This rule ensures that plans:

•  Have systems and processes in place for all aspects of the marketing program,
• Provide oversight of those systems and processes, and
• That those processes are clearly defined and understandable.

As is always the case with these regulation documents, the focus of energy should be on providing the most transparent information possible for the beneficiaries and end users. Plan marketing needs to be developed in such a way as to provide the clearest possible idea for what a beneficiary is getting into.

Be sure to join us next week, as we delve deeper into the 2013 CMS Marketing Guidelines.

-------------------------------------------------------------------------------------------

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.

CMS Announces New Marketing Regulations (Part 1)

CMS has approached the 2013 Marketing Regulations with a critical eye, and an editorial focus. In an effort to simplify and clarify the rules, CMS has removed around 70 pages from the document. Over the next few weeks, we’ll look at some of those changes, and explore what motivated CMS to make such drastic edits.

For starters, let’s take a look at some of the motivating factors behind these changes.

Focus on Marketing Requirements

CMS rules in previous years may have been unnecessarily complex or confusing. 2012’s Rules document makes an attempt to lessen that confusion by narrowing the scope of the regulatory focus. It makes sense at even the most basic level: if you have less information to take in, you are more likely to take in all of it, right?

Eliminate Redundancy

Here is another easy win. CMS took a critical look at the 2013 Marketing Guidelines, and cut out any repetitious, redundant, or pointless language. The result is more concise, easily-digested content.

So what did all of this renewed focus get us? The regulation document breaks down to three guiding principles. Here is the first:

Plan sponsors are responsible for ensuring compliance with CMS’ current marketing regulations and guidance, including monitoring and overseeing the activities of their subcontractors, downstream entities, and/or delegated entities.

This applies to anyone that a plan has delegated some responsibility to implement, and includes – but is not limited to – marketing events, marketing materials, the distribution of those materials, and collecting or disseminating information.

Next week, we'll look at the two other guiding principals.

-------------------------------------------------------------------------------------------

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.

Studies Point Out Simple Solutions to Patient Readmission

Over the past week, numerous headlines have broken regarding one of the biggest problems in the health industry this year. Patient readmission is still a huge issue, but in almost every case, the culprit is lack of education and laziness. Sound harsh? Let’s look at the data.

“Several New York-area hospitals will lose millions of dollars in federal Medicare payments,” begins this WNYC report, “because too many of their patients keep coming back — and the government's tired of paying for it. “ Increasing numbers of hospitals are noticing a rise in patient readmission, and the blame seems to lie at the feet of those very facilities. HealthDay claims that

Results of medical tests done just before patients leave the hospital often go unread and are not acted upon, posing health risks to a significant number of patients… Close to half of the tests ordered on the day of discharge are never looked at again, [Enrico Coiera, director of the Center for Health Informatics at the Australian Institute of Health Innovation at the University of New South Wales] said.

"Some of these are unnecessary and represent a major opportunity to save on costs," he said. "Others are clinically significant, and should be followed up."

According to Coiera’s findings, nearly half of the test results ordered on the day of discharge are never seen by doctors. This puts patients at a severe disadvantage, and increases the likelihood of readmission.

However, some hospitals are firing back at those accusations. According to the WNYC report,

Some safety-net hospitals that treat large numbers of low-income patients tend to have higher readmission rates, which the hospitals attribute to the lack of access to doctors and medication these patients often experience after discharge. The analysis of the penalties shows that 76 percent of the hospitals that treat many low-income patients will lose Medicare funds in the fiscal year starting in October… Medicare disagreed, writing that “many safety-net providers and teaching hospitals do as well or better on the measures than hospitals without substantial numbers of patients of low socioeconomic status.”

What do you think? Will we see a drop in patient readmission any time soon? Are Medicare’s efforts helpful, or harmful? Tell us in the comments below.

 

-------------------------------------------------------------------------------------------

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.

A New Threat to Health Providers?

We’ve written time and time again about faulty security practices that lead to data breaches and victimized patients. Now, it seems the shoe is on the other foot.  An increasing number of health providers are reporting cases of Medical Identity Theft. In this variation of a common 21^st century crime, scammers track down insurance cards, social security numbers, and fake IDs to impersonate physicians and health workers. They are then able to use these credentials to make millions off of Medicare.

Worried, yet? It gets worse. Medicare isn’t the only victim of these crimes; physicians that are targeted for these scams suffer more than monetary loss.

Physicians also face repercussions when their patients’ identities are stolen. Patients report losing trust in their physicians after a medical ID theft has occurred. There is also the potential for medical errors and bad outcomes caused by two patients using the same identity. Physicians also potentially could be subjected to violations of the Health Insurance Portability and Accountability Act if they did not adequately protect the data from being stolen.

That’s right. Not only are physicians responsible for repaying Medicare and any incurred taxes (costs which quickly add up to an average of $22,000), they can also be held responsible for any damage their patients face at the hands of ID scammers. So, what can be done? The warning signs of Medical ID Theft are actually easy to spot, if you know what to look for. American Medical News lists things as simple as checking Medicare remittance notices for suspicious services, and checking Medicare’s Provider Enrollment, Chain and Ownership System for practices associated with your name that aren’t related to your own.

Click here to see American Medical News’s full article on avoiding Medical Identity Theft.

-------------------------------------------------------------------------------------------

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.