CMS has order three private MA plans to stop marketing and enrollment activity: Universal American Corp. (UAM), Health Net Inc. (HNT) and Arcadian Health. Not a good time to stop enrolling members in the middle of the 2011 AEP! Further References: Kaiser Health News Stockton (Calif.) Record: “These sanctions will remain in effect until...
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MA, MAPD and PDP plans are required to report measures to CMS for Part C and D benefits. Additionally, plans are required to contract with an outside vendor to review and validate the data that was submitted to CMS. Attached is CMS’s standards that plans should use to select a validation vendor. Vendor should...
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CMS and the FDA are coordinating with each other to ensure the market is aware of the changes to the regulatory status of marketed prescription drug products. The Non-Matched NDC List represents drug products that have not been properly registered and listed with the FDA. The non-match FDA list is NOT to be used...
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CMS provided new guidance on HMPS today on changes to their edit logic for PDE transactions submitted to CMS system, DDPS. Summary of Changes: PLAN BID TABLE – New table that contains abbreviated plan bid information including the plan’s ICL, and application for supplemental benefit coverage MANUFACTURER AGREEMENT TABLE - This will be the...
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Today CMS sent a HPMS memo clarifying the use of DRAFT Plan Ratings Data that became available on 9/15/2010. MA, MAPD and PDP plans should NOT use these rating scores in any marketing materials or communications. There is the reality that potential findings from CMS or other Plan Sponsors may change final calculations and...
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ECRS is the CMS contractor system used to submit changes in Coordination of Benefits information for Medicare members. The contractor reviews the change requests. Once the requests are verified they are confirmed back to the plan in the CMS COB file. This process is key to maintain correct MSP information for members. All plans...
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In a significant move to reduce Fraud Waste and Abuse CMS has developed and is providing ‘Comparative Billing Reports’ to Medicare providers with the exception to Physicians and Inpatient hospitals. I would expect to see many more investments in new processes, transparency and compliance requirements to identify errors and outliers in billing and the...
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From CMS via HPMS on Sept 3, 2010: “On August 11, 2010, we issued a memo describing corrections to the 2011 Annual Notice of Change/Evidence of Coverage. We have the following additional corrections. 1 – Under the bullet, EOC Chapter 4, section 2.1, Your medical benefits and costs as a member of our plan,...
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That time of year again! CMS has distributed via HPMS the 2011 MA and PDP Readiness memo. Make sure you incorporate in your plan a review of the checklist and implement any corrective action to ensure your plan is in compliance. CMS has been increasing their review of plans and this checklist is your...
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All MA organizations (MAOs) that are effective before 1/1/2009 must submit a QIP and CCIP to CMS using their standard submission templates. The templates can be found here: http://optimalsolutionsgroup.com/CMS/index.html Questions can be answered by the CMS contractor: EMAIL: maqro@optimalsolutionsgroup.com PHONE: 866-962-6826 CMS has extended the data submission deadline to Aug 27, 2010. This is...
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