WEBINAR: Tactical Solutions Supporting the Challenges of ANOC/EOC Creation-Print-Distribution-Reporting Requirements

Merrill Corporation is hosting a Free Webinar and You're Invited!


Title: Tactical Solutions Supporting the Challenges of ANOC/EOC Creation-Print-Distribution-Reporting Requirements.
Date: Wed, March 28
Time: 1:00pm Central Time
Duration: 1-hour
Cost: FREE!

A streamlined process for the creation, print, distribution and reporting of your ANOC/EOC program is crucial to successfully meeting the regulatory requirements as well as ensuring the integrity of PHI, and minimizing the risk associated with HIPAA violations. 

In this webinar you will:

• Review current technology and manufacturing workflow innovations and best practices associated with ensuring the final product is produced on time and correctly.  We will examine everything from the latest dynamic document creation technology to effective use of the postal intelligent mail barcode.
• Learn how our advanced reporting allows you to track delivery at the piece level.  See how the use of a personalized 2D barcode scan during manufacturing translates into member level reporting. 
• Discover what options are available for a hybrid print and e-fulfillment workflow. 

 
Click below to register for this webinar today!

http://bit.ly/MerrillWebinar328

Middle Class on Medicaid?

There has been no shortage of controversy surrounding the Obama Administration’s Affordable Care Act. Recent debates have brought up the 10 million additional children and 20 million additional adults Medicaid will be picking up. We’ve also seen dialogue on the 138% poverty level, and access gained by childless adults. Now, a new unforeseen problem in the legislation’s wording will allow early retirees to jump on the Medicaid bandwagon.

Two years from now, many people will begin early retirement, leaving the workforce at 62. During the three years between their retirement and joining Medicare at 65, social security payments will not count toward their annual income mix. This will allow up to 3 million early retirees to gain access to Medicaid in 2014.

Many of the legislators on Capitol Hill are concerned that overloaded state Medicaid programs will further crumble under this flaw. Presently, the administration has addressed the problem, and is seeking a solution, but until something is presented, this is simply another hiccup adding fuel to the anti-ACA flames.

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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.

Census Says Life Expectancy is Up, But Why?

Recent census data shows that the US average life expectancy has increased to a record-breaking 78 years. The immediate thought that most people have when presented with this information is that improving medical technology and increased health is leading to longer lives. To some extent, that is true. While there is a clear correlation between life expectancy and medical advances, this number does not really mean that the average person is living a longer life.

In reality, average life expectancy is determined almost entirely by infant mortality rate. In this most recent report, the CDC listed “a record low of 6.42 deaths per 1,000 live births, a drop of nearly 3% from 2008.” This number was 100 out of 1000 as recently as 1920, creating a statistic that implies that most people are living up to twenty years longer than they have in the past. This is simply not true.

Death rates are likely to continue dropping over the next decades as medical advances remove the threat of curable disease. The increasing unpopularity of smoking adds to this number as well.  This ratio of infant-mortality and death rate will continue to influence life expectancy, but we do not need to start worrying about running out of retirement homes any time soon.

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.

THE SOLUTION:

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.

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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. Pam can be contacted at Pamela.Argeris@merrillcorp.com.

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:

THE CHALLENGE:

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.

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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.

Mandated Member Communications: It’s the Most Wonderful Time of the Year?

“It’s the most wonderful time of the year

with the kids jingle belling and 

everyone telling 

you’ll be of good cheer

It’s the most wonderful time of the year.”

Let me be the first to say that it’s pretty clear Andy Williams did NOT work at a health plan!!

While he is singing about parties for toasting and marshmallows for roasting, the rest of us are neck deep in the enrollment season and the stress, long hours and craziness that go hand-in-hand with this supposed “most wonderful time of year”.

Health plans are in the middle of orchestrating a successful enrollment season. With three major communication initiatives occurring, plans must create, produce and distribute Agent/Broker Communications, Pre-Enrollment materials and Post-Enrollment materials accurately, on time and within compliance. Any mistake made along the way can have a devastating effect on the plan’s ability to attract or retain members. Because of this, plans have a laser focus on these activities ensuring they are executed flawlessly.

Often lost amongst all these activities is another major initiative that needs to be handled with kid gloves: Preparing and executing mandated post enrollment communications. While these communications often fly below the radar during this time of year, they can have a major impact on a business if they are not handled properly. With changing regulations, new exhibits and addendum, and increased monitoring by regulatory bodies, failure to adhere to the requirements can lead directly to penalties for non-compliance including monitoring, fines, and the risk of contract non-renewal.

While the other communications rightfully get most of the attention and resources, don’t let mandated member communications be the straw that breaks the camel’s back. Preparing, distributing, and reporting on mandated member communications is often a resource-draining and time-consuming process, and with the enactment of the Affordable Care Act and tightening regulatory guidelines, the process has only been compounded. Worse, failure to comply with strict service level agreements and deadlines can result in penalties, including monitoring, fines, and the risk of contract non-renewal. Taking the proper time will build positive momentum and will ensure that all your other enrollment activities were not for naught.

And you know what, if all of these communications are executed properly, this year’s enrollment season could very well end up being "the most wonderful time of year" for your plan.

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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.

Mandated Member Communications in Healthcare: An Introduction

Preparing, distributing, and reporting on mandated member communications is often a resource-draining and time-consuming process. The enactment of the Affordable Care Act and tightening regulatory guidelines have only compounded this already trying process. Worse, failure to comply with strict service level agreements and deadlines can result in penalties for non-compliance including monitoring, fines, and the risk of contract non-renewal.

Today, this blog is commencing a series on the topic of mandated member communications, including the different types that currently (and potentially) could exist, as well as new methods for companies to improve their process for staying compliant.

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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 her at Pamela.Argeris@merrillcorp.com.

OPM Shows Little Concern for Privacy

OPM is making waves with their push toward a national database of health insurance customers. OPM’s argument is that such a database would provide "best value for both enrollees and taxpayers.” They also cite the potential efficiency such a system would offer. OPM also claims that the system would be “de-identified,” supposedly protecting individual customers from the healthcare data-mining that plagues the industry.

However, many are not satisfied with OPM’s vague claims. Harley Geiger, policy counsel for the Center for Democracy and Technology, tells Computerworld “[At this point,] there are far too many unknowns about the program for it to be acceptable.” Many questions are raised by the program: Are HIPAA and PHI going to be swirling around cyberspace? Exactly what measures are protecting consumers from data mining?

Most seem to agree that OPM’s notice is entirely too vague to garner any form of support for the new system. OPM’s plans to allow third-parties to access the material, including judicial and research groups, sends up further red-flags.

Until OPM is willing to release more specific information about the program, it is unlikely to be welcomed into the industry. Our concern should be for the protection and safety of consumers and average citizens, not for cost-cutting. If there is even a small potential for someone to profit from selling access of this database to commercial data-miners, then it is unacceptable as a system.

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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.

HHS, IT Infrastructure and Health Insurance Exchanges

Last week, HHS announced a new initiative that will provide competitive funding opportunities for states to design and initiate IT infrastructures that will be necessary for the operation of Health Insurance Exchanges. Because these Exchanges will need to be designed to present a large number of individuals and small businesses with affordable health care options by 2014, new and advanced IT systems will be necessary well before then.

Exchanges, as we know, will provide a form of one-stop shopping for individuals and small businesses, with interested parties being able to examine, select, and enroll in one of many available plans offered at competitive, affordable prices. However, while many are focused and debating the policy aspect of this initiative, what gets lost is the IT infrastructure that will need to be constructed in order to make this (or any) end goal possible. The infrastructure will need to be well thought out and be based on several best practice examples (especially in the areas of simplicity and approachablity) in order to allow the Exchanges to operate like other similar consumer industry sites.

To assist with this aspect, states can apply, through HHS, for “Early Innovator Grants.” The grants will provide states with the capital to get a head start on building these necessary infrastructure models. States are to be chosen based on their current efforts toward consumer-friendly IT infrastructure, as well as their leadership in cost-effective solutions.

The first round of winners will be announced before February 15^th, 2011, and will be followed by additional award announcements which all states – including those that already received funding – will be eligible to receive.

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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.

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 28^th. 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.

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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.

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.

Comments on Director Blum's Message at the CMS Fall Conference

As noted in our previous blog post, Merrill Corp attended the Center for Medicare and Medicaid Services (CMS) 2010 Fall Conference earlier this month. On Day 2, before sessions on Customer Service Monitoring, QIP/CCIP Expectations and a panel on 2010 audits by the CMS Central Office Representatives, Deputy Administrator and Center for Medicare Director Jonathan Blum gave a presentation to the health plans in attendance.

Blum, who we have posted about in the past, made several key points, with the most interesting being his comments on marketing materials (CMS will be closely monitoring them to ensure accuracy and honesty) and on the change in way CMS interacts with health plans (in reaction to comments from some plans on feeling that CMS has greatly changed the way it interacts and partners with them, he confirmed that yes, there has been a change and that it is intentional). Additionally, he covered a wide-range of topics, including:

• Enrollment
• Surveillance Activities
• 2011 Selling Season
• Health Reform and the Affordable Care Act (ACA)
• Plan Sponsor's Responsibilities
• Plan Risk and protection of beneficiaries
• CMS Communication to beneficiaries 

From Merrill Corp's perspective, we commend the director's statements and feel that is in parallel with Merrill's philosophy on compliance-driven communications. In the coming weeks, we will dive deeper into these discussion points and provide insight on how Merrill Corp can assist with the upcoming changes.