Medicare Secondary Payer (MSP) is all about the money.

Money going out as a result of paying claims as primary payer when it’s possible you should be paying as secondary payer. CMS reduces plan payments for members with MSP, shown on the Monthly Membership Report (MMR) as an MSP adjustment (reduction).

Kaiser Family Foundation & CCF Release 50-State Survey on Medicaid and CHIP

It’s time again for the release of the annual 50-state survey on Medicaid and CHIP enrollment, eligibility, cost-sharing and renewal policies conducted by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured with the Georgetown University Center for Children and Families.

2016 CMS Applications: Highlights and Basics

This week’s CMS industry training on applications was quite informative, and contained many audience questions that you will want to hear.   The recording is already available to registrants for those who missed it.  There was way too much information for me to summarize, so I have included here a few highlights from the call and some basics that are easily overlooked.


How to Maintain the Accuracy & Consistency of Data through an Entire Life Cycle

It doesn’t matter whether you call it the Annual Election Period (AEP), Open Enrollment Period or Fall Open Enrollment; it’s that busy time of the year when beneficiaries are on the move. Now that the dust has settled, it’s time to take a thorough look at your member data. Your members are your revenue. Accurate member data and continuous maintenance will yield the maximum, most accurate level of revenue to your organization.

Private label health plans – a tool for increase market capture and improved patient outcomes

Private label health plans or co-branded health plans are joint efforts between like minded health plans and provider organizations interested in enhancing market share, achieving improved patient outcomes, minimizing duplication of services and achieving financial accountability.

2016 CMS Application Season Begins

Yesterday CMS released the 2016 Part D application, and this afternoon the 2016 Medicare Advantage (MA) application was released.  Despite the applications’ release dates, potential and current Plan Sponsors should be well under way in the preparation of the upload that is due on February 18th.  Aspects of the application that require significant lead time to accomplish includ

ICD-10 Transition – Ready or Not?

It’s a New Year and there are 262 days left until the October 1, ICD-10 implementation deadline. The road to ten has been very challenging with respect to “Go or No-go” implementation timelines. Due to several delays, many organizations literally stopped transition efforts and redirected funding budgets to other priority projects.

ACOs – There Must Be a Pony in Here Someplace

We’ve all heard that story.  Now, CMS is in that proverbial barn and with the proposed rules, have doubled down on the time they’re taking to look for ACO success at managing risk.   Does it make sense given that only two current ACOs have gone to the two-sided risk model?  My guess is that is not what they are really looking for in just another three years.

New Year’s Resolutions for Your Organization!

Every January 1st we have the opportunity to reflect on our prior year. We make lists of all the things we want to do or maybe do better in the upcoming New Year. The typical resolutions are lose weight, quit smoking, save money, exercise more, eat healthier, create a budget or plan a trip. The practice of evaluating our personal life is a good way to celebrate our accomplishments while thinking about ways we can improve in the New Year.