Managing Medicare » Enrollment

Be Prepared for Spring 2011 MARx System Upgrades! Will You Be Ready?

jbaker — Tue, 29 Jun 2010 14:33:28 +0000

CMS has planned a major overhaul of their MARx system impacting enrollment file layouts and changes to TRR processing in April 2011. Here is a run down of the changes:

IMPACTED SYSTEM / INTERFACE	DESCRIPTION	FROM	TO
Enroll Disenroll File	Combining transaction codes 60, 61, 62 and 71 in to a single transaction code 61. The file layout will be changed and processing logic will be updated – MAJOR IMPACT	PLAN	MARx
Enroll Disenroll File	Submission Cut-Off Dates are aligning to calendar months, allowing for clear transaction submission based on CMS policy and compliance. – MAJOR IMPACT	PLAN	MARx
Enroll Disenroll File	CMS is creating a new process for canceling enroll and disenroll transactions that have already been submitted to CMS. There will be new transaction types (TC 80- enroll cancel and 81 – disenroll cancel) that will cancel the transaction. CMS will no longer allow for ‘opposite’ transactions to cancel transactions. – MAJOR IMPACT	PLAN	MARx
TRR	New TRCs from CMS will notify the Plan when retro changes to a member’s NUNCMO and LEP have taken place to a member. All plans will receive this information regardles of enrollment dates and withholding status. – MINOR IMPACT	MARx	PLAN
Enroll Disenroll File	CMS will automatically reset a member’s NUNCMO to zero when they turn 65 and enter another IEP for Part D – MINOR IMPACT	MARx	PLAN
TRR	Gone are TRC 165 errors! The processing of enrollment and payment are separated with this CMS upgrade and errors in payment processing will NOT block enrollment processing anymore – no more TRC 165! – MINOR IMPACT	MARx	PLAN
TRR	Daily TRR Files!This is great news. BCSS files will go the way of the dinosaurs and the TRR will be the daily batch response to plan submissions.In addition to faster response the layout will change to include all of the data that was submitted, confirming the values of the submission transaction– MAJOR IMPACT	MARx	PLAN
Enroll Disenroll File	Submit member address changes to CMS using a new transaction code, 76 rather than sending SCC changes to the retroactive processing contractor. – MAJOR IMPACT	PLAN	MARx

All of this and more will dramatically change the way plans report and exchange data with CMS and MARx. These changes are GREAT NEWS for plans that are prepared to move with CMS. The proposed changes will greatly simplify processing rules and improve traceability with data exchanges with CMS. However for those that do not have a plan and resources to execute will be at a great deal of risk.

Will you be ready to meet the new system and compliance requirements by April 2011?

DOWNLOAD THE CMS MEMO HERE.

VIVA Health, Inc. Selects Dynamic Healthcare Systems Suite

jbaker — Sat, 26 Jun 2010 04:42:18 +0000

FULL DISCLOSURE: I do work for Dynamic Healthcare Systems, but news none the less:

Dynamic Healthcare Systems, a provider of enterprise technology solutions for Medicare-focused health plans, today announced that VIVA Health, Inc., a managed care company with over 32,000 Medicare Advantage members, purchased the Voyager suite including the following modules: Sales/Marketing, Enrollment, Reconciliation, HCC Analytics, RAPS Management and Premium Billing. Dynamic Healthcare Systems is designed to ensure health plans meet the complex compliance and data processing requirements to be properly compensated.

“After reviewing several technology options for managing enrollment and risk adjusted payment, we selected Dynamic’s suite of solutions because they offered the right combination – a comprehensive software solution and expertise in this field,” said Libba Yates, VIVA’s Vice President of Corporate Development. “We value the ability to create an integrated view of our Medicare business and process transactions in a single system.”

The Voyager solutions enable a plan to eliminate compliance risks associated with sales/marketing, enrollment and member management, and risk adjustment requirements by controlling and monitoring operational processes. In addition, plans are able to optimize their premium payments from CMS by correctly, accurately and timely creating, submitting and reconciling enrollment and risk adjustment transactions with CMS.

“To gain a competitive edge today, health plans have to manage and integrate their operations across departments,” said Ken Stockman, Founder and Chief Executive Officer of Dynamic Healthcare Systems. “Voyager is designed to allow plans to eliminate operational barriers between departments and take advantage of the cost and risk reductions and payment optimization that integrated delivery organizations enjoy.”

CMS Takes Steps To Clean Up Enrollment

jbaker — Wed, 29 Mar 2006 15:30:11 +0000

Last week CMS notified Medicare prescription drug plan sponsors of the process for reconciling plan enrollments to ensure that all beneficiaries who have elected to change plans are appropriately disenrolled from their initial plan by April 30, 2006. To ensure that all enrolled beneficiaries would have access to prescription drug coverage in the early days of the new program, particularly for dual-eligible beneficiaries who switched plans later in the month, CMS advised plans in January to delay processing certain disenrollments. By early February, most plans began processing disenrollments. As a result of the January CMS instruction and some plans’ decision to continue delaying disenrollments into February or March, certain beneficiaries have had access to coverage under more than one plan: the initial plan that continued coverage, and a subsequent plan chosen by the beneficiary or an agent acting on their behalf (the Medicare “plan of record”). As the startup of the drug benefit progresses, CMS is now taking steps to ensure that all beneficiaries who changed plans are appropriately disenrolled from their initial plan by April 30, 2006. This process of reconciling plan enrollments will assure consistent coverage, allow appropriate tracking of out-of-pocket costs, permit payments to be fully reconciled between plans, and most importantly, ensure that each beneficiary continues to receive drug coverage smoothly and consistently. Please find attached a one-pager that further describes this process. The standard letters sent to affected beneficiaries on CMS letterhead are also attached for your reference.

Bush Says He Opposes Extending Deadline for Medicare Enrollment

jbaker — Thu, 16 Mar 2006 00:07:10 +0000

Bloomberg is reporting, President George W. Bush said he opposes extending the deadline to sign up for a new Medicare prescription drug benefit even though some of the people who are eligible may be confused about the program.

Highlights From January 26 Region IX Stakeholder Call

jbaker — Thu, 26 Jan 2006 23:38:43 +0000

Following is a brief overview of the stakeholder conference call lead by Jeff Flick today:

States On Track To Federal Part D Reimbursement – The Federal Government is moving to quickly provide a process to reimburse states who have stepped up to be the payer of last resort for duel Medicare beneficiaries who have had problems accessing the medications they need during the transition to Part D coverage. (Newsday.com Story)

Clarification On The First Fill Rule – According to CMS the first fill rule is applied to all new members regardless of when they enroll in the system. The rule is NOT applied to January 2006 only.

Managing Beneficiary Expectations – The letter of the MMA law states that a beneficiary can enroll in to a new plan on the 31^st of the month and receive the plan benefits on the first day of the next month, the next day in this case. New language is being drafted by CMS to help plans manage the expectations of beneficiaries who submit elections near the end of the month.

Pharmacy Exceptions Communication Challenge – Beneficiaries are not generally educated on their specific plan’s pharmaceutical exception and prior authorization process, resulting in confused, frustrated and at risk beneficiaries with out an understanding as to why they can not access their medications and how to resolve their problems. Plans are encouraged to reach out to their beneficiaries directly and through advocacy groups to help them sort through the challenge and resolve the conflict.

WSJ article on Part D Enrollment

Ken Stockman — Thu, 26 Jan 2006 17:53:46 +0000

In this article The Wall Street Journal outlines the aggressive land grab going on right now in the Medicare marketplace as plans use Part D enrollment to capture new applicants and then attempt to migrate them to a full Medicare Advantage program. Also, the article discusses AARP’s influence on the senior population and the success some plans are having with enrollment despite the challenges of implementation by CMS.

WSJ Article

NEW Report: Tracking Medicare Health And Rx Plans

jbaker — Tue, 17 Jan 2006 16:35:13 +0000

January 6^th, 2006 – Monthly Report for December 2005

The Kaiser Family Foundation releases a great monthly update on activites that impact Medicare Advantage and PartD businesses.

Credits:
Prepared by Stephanie Peterson and Marsha Gold, Mathematica Policy Research Inc. as part of work commissioned by the Kaiser Family Foundation

Download MA Plan Tracking Report

CMS: Serving Pharmacists Is Serving Beneficiaries

jbaker — Wed, 11 Jan 2006 18:50:01 +0000

As we continue to address Medicare drug benefit implementation issues with Plans, one message we are trying to instill in everyone is that the best way to serve plan beneficiaries is to make the process easy for pharmacists. To that end, we hope that you will take a moment to read these tips from NDCHealth (now Per-Se Technologies) on how to optimize pharmacists’ use of the E1 enrollment query. The E1 is proving more valuable every day as we continue to augment the system with enrollment data. Improving match rates on the E1 and getting pharmacists correct information on the first try will help us ease the burden on pharmacists which serves the interests of Medicare beneficiaries.

Thanks for your continued support and service to Medicare beneficiaries.

EligibilityTipsforPharmaciesMDC011106Final.pdf

S. Lawrence Kocot
Senior Advisor to the Administrator
Centers for Medicare and Medicaid Services (CMS)

Delay In The Implementation Of The Deficit Reduction Act of 2005

jbaker — Tue, 03 Jan 2006 18:38:45 +0000

According to a December 30, 2005 CMS press release, The delay in the implementation of the Deficit Reduction Act of 2005 will delay the following changes among many others:

As required under current law, claims for physicians’ services on or after January 1 will be paid with the -4.4 percent reduction from 2005 levels. The bill would have kept physician payment rates from being reduced, and would have provided significant offsetting savings to limit any impact on beneficiary costs
The base composite rate paid to end-stage renal disease facilities will not increase from 2005. The bill would have implemented a 1.6 percent increase.
Home health agencies will receive payments reflecting a 2.8 percent increase on January 1, rather than the zero percent increase as recommended by MedPAC and specified in the bill.

However , CMS expects congress to take up the bill again after congress reconvenes and is ready to “make all appropriate payment changes in the least burdensome manner possible.”