Managing Medicare » Part D

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.

Medicare | House Democratic Caucus Asks CMS To Help Low-Income Medicare Beneficiaries Enroll in Prescription Drug Benefit

jbaker — Tue, 30 May 2006 18:18:52 +0000

Nearly 150 members of the House Democratic Caucus have sent a letter to CMS Administrator Mark McClellan urging him to take additional steps to enroll low-income beneficiaries in the Medicare prescription drug benefit, CQ HealthBeat reports. The letter asks CMS to take several steps, including working with the Social Security Administration to identify low-income beneficiaries who might be eligible for assistance with deductibles, premiums and copayments. Rep. Lloyd Doggett (D-Texas), a member of the House Ways and Means Subcommittee on Health, said, “The administration must make an extra effort to notify seniors entitled to extra help.” CMS spokesperson Jeff Nelligan said the agency will review the letter (CQ HealthBeat, 5/26).

Source: Kaisernetwork.org

Part D Weely Calls to Be Terminared

jbaker — Tue, 30 May 2006 16:15:52 +0000

Since December of 2005 we have been holding weekly Part D Providers conference calls to address issues physicians and other health care providers were having with Part D. We have seen a gradual decline in the participation on those calls and this past week, we only had one question on the call. To that effect, we are going to hold the final weekly Part D Providers call on May 30th at 2pm EST.

We continue to remain committed to fixing your Part D issues and we are confident that between your email access to us

(PRIT@cms.hhs.gov) and our participation in the Open Door Forums (ODF) you will not feel abandoned. We are asking that physicians and other health care providers take their Part D issues to their respective ODF calls. If you do not currently participate in the ODFs, you are encouraged to sign up to receive the ODF announcements by going to: http://www.cms.hhs.gov/apps/mailinglists/default.asp?audience=4 or http://www.cms.hhs.gov/opendoorforums/

Again, the last Weekly Part D Providers call will occur on May 30th at 2PM EST. The next Skilled Nursing Facilities/Long-Term Care ODFs is June 6th (1-800-837-1935, Reference ID: 8266876) and the next Physician ODF is June 27th. Both will start at 2pm EST.

Payment Increases to Medicare Advantage Plans Lower

jbaker — Tue, 04 Apr 2006 17:41:49 +0000

CMS on Monday said that reimbursement rates for Medicare Advantage plans in 2007 will increase by only about 1.1% on average, rather than 4% as scheduled, because of a technical adjustment of how physicians code beneficiaries for billing, CQ HealthBeat reports. According to CQ HealthBeat, past small increases in reimbursement rates have led to decreases in benefits offered by Medicare Advantage plans.

Medicare Advantage plans in most cases offer more benefits than traditional Medicare because of higher reimbursement rate increases established under the 2003 Medicare law, in addition to separate subsidies from the federal government for plans that provide prescription drug coverage.

Karen Ignagni, president of America’s Health Insurance Plans, said, “No member of Congress will be able to conclude that plans are overpaid next year.”

Health Plans Don’t Fear 2007 Medicare Advantage Rates, See Positive Long Term

jbaker — Wed, 29 Mar 2006 19:07:26 +0000

CMS is expected to issue final 2007 Medicare Advantage (MA) payment rates April 3. But some established Medicare managed care organizations aren’t holding their breath: They anticipate satisfactory reimbursement for next year’s MA product lines….

Visit AISHealth to read the entire story.

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.

DEADLINE: PDPs, MA-PDs, Cost, and PACE 2007 Applications

jbaker — Mon, 20 Mar 2006 20:35:10 +0000

Today is the deadline for all PDPs, MA-PDs, Cost, and PACE 2007 applications.

Details on the CMS website.

Market Responce: Get the Word Out Tours

jbaker — Mon, 20 Mar 2006 16:12:34 +0000

Private providers are hoping to clear up the confusion over the new Medicare Prescription Drug Plan with road trips to enroll new members and by offering information to consumers about competing plans.

Representatives for Humana, one such provider, will answer questions for the public from its “Let’s Talk” tour bus, which will be at Wal-Mart stores on the East Side today and in Northeast El Paso on Tuesday.

Ross McLerran, spokesman for Humana in San Antonio, said the company’s 10 mobile units began the nationwide tour last year. The tour is set to end on April 1, after stops at 1,187 Wal-Mart stores, and senior and community centers in 408 U.S. cities.

“We had 200,000 visitors as a result of the tour so far,” McLerran said.

Public Comment Period for Draft 2007 MA, MA-PD and PDP Call Letters

jbaker — Thu, 23 Feb 2006 22:46:23 +0000

We are pleased to issue this notice announcing the release of the DRAFT 2007 Medicare Advantage (MA), Medicare Advantage-Prescription Drug (MA-PD) and Stand Alone Prescription Drug Plan (PDP) Call Letters for public comment. We are sending theseletters out via HPMS and will post them on our website at
http://www.cms.hhs.gov/HealthPlansGenInfo/02_WhatsNew.asp#TopOfPage

and

http://www.cms.hhs.gov/PrescriptionDrugCovContra/01_Overview.asp#TopOfPage

CMS UPDATE: Advance Notice of 2007 Technical Changes to MA Reimbursement

jbaker — Sat, 18 Feb 2006 03:58:05 +0000

Here are the highlights from the CMS Advanced Notice of Methodological Changes to 2007 MA Rates and Part D Payments:

GENERAL:

The National Per Capita Growth percentage is used to baseline the rate tables for 2007. The rate is estimated at 6.9%. It is still not possible to predict the final impact on reimbursement with out knowing the other variables, like the Budget Neutrality and Coding Intensity factors.

PART C:

The HCC model will be recalibrated for 2007 using 2002 and 2003 Fee For Service data. The current model is based on 1999-2000 data. It is expected that the new model will provide a more accurate prediction between health status and the costs associated with providing care. All segments will be updated (community, long-term institutional, new enrollee, and ESRD). There are no changes to the disease grouping in the model however coefficients (the higher the weight allocated to a grouping the higher the reimbursement). As a result of the recalibration of the HCC model, the frailty factor will also be recalibrated.
The Fee For Service Normalization factor will be recalibrated for 2007 and will no longer be applied to the rate book but to the risk scores. The expectation is that mathematically the result will be the same. However between recalibrating the HCC model AND applying the FFS Normalization factor to the risk scores, the 2007 risk scores will be substantially different in 2007 and not really an apple-apple comparison to 2006 scores
In 2007 Pain Management will be added (Medicare code 72) to the qualified specialty type and pain management has been added to the HCC model.
100% risk adjustment payments in 2007 for all MA plans except Social Health Maintenance Organizations (S/HMOs), Minnesota Senior Health Options (MSHO)/ Minnesota Disability Health Options (MnDHO), Wisconsin Partnership Program (WPP) and Massachusetts Senior Care Options (SCO) demonstrations who will be 75% risk adjusted in 2007.
The budget neutrality factor will begin its’ phase out in 2007 with a 45% reduction.

DOWNLOAD THE CMS ADVANCE NOTICE HERE