The Medicare “Doc Fix”

The “doc fix,” as just passed by the House of Representatives, would fix the annual sustainable growth rate (SGR) calculation by eliminating it.  The SRG was enacted nearly 18 years ago as a way to tie physician compensation under Medicare to the growth in the national economy.  It has never worked well, and Congress has had to override it 17 times to prevent sizeable cuts to Medicare’s physician payment rates.  The current SGR cut is about 21% and will take effect March 31 of this year.

Is the “NUNCMO” Nightmare Keeping You Up at Night?

The recent MAPD Help Desk Memo, dated 3/3/15, advises that on March 8, 2015, “The Centers for Medicare & Medicaid Services (CMS) will be performing a clean-up to process “73” transactions that contain NUNCMO (Number of Uncovered Months) value from the extraneous NUNCMO row that was removed in Phase 1 multi-phase NUNCMO data clean-up which occurred on March 23, 2014.  The effective start date of this transaction will be the preceding Part D enrollment start date.”

The Model of Care: More than just a technical requirement

The Model of Care (MOC) represents the backbone of a health plan’s operational infrastructure and offers powerful potential through which to drive quality improvement, service excellence and improved health outcomes.

Partners Needed

I calculated the total amount of civil monetary penalties (CMPs) levied by the Centers for Medicare & Medicaid Services (CMS) last year on Medicare Advantage and Part D plans, and it’s a big number: $4,925,150. There were also five suspensions in 2014.

The Annual Full Replacement COB Files Are on Their Way

It’s that time of year again when Part D plans will receive full replacement Coordination of Benefits (COB) files from the Centers for Medicare & Medicaid Services (CMS).  The Health Plan Management System (HPMS) memo dated 3/6/15 states that the 2015 Full Replacement COB files will be sent to organizations beginning March 19th.  Plans will need to distinguish these files from daily COB notification files by the date of receipt and the file size. Easy enough? Not exactly. 

Opportunity to Review and Correct Your Records

Key Changes to Star Ratings from 2016 Draft Call Letter

Now that the news from last month’s 2016 Advance Notice (also known as “the Call Letter”) from the Centers for Medicare & Medicaid Services (CMS) has had time to sink in, it’s time for the real work to begin.