The Risk in DIY: CMS Mandated Material

“Do It Yourself”, or DIY, has been the rave for years now.  From social media sites like Pinterest to television networks like HGTV, Americans have become fond of this philosophy.  Now, I am a big believer in being self-sufficient and must say that I have been sucked into marathon viewings of DIY shows often (Nicole Curtis of Rehab Addict is no joke!).  And, while I have seen my share of success stories, more often than not, I see DIY projects result in complete frustration from those attempting to DIY and very costly mistakes.

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.