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Congress Takes Another Look at Regulating Prices

While the proposed American Health Care Act never made it to a vote, that doesn’t mean that Congress is done trying to regulate various aspects of the healthcare system.

The First 2017 Audit Notices

At the annual HCCA Managed Care Compliance Conference in Scottsdale, AZ, the new director of CMS’ Medicare Parts C and D Oversight and Enforcement Group (MOEG), Vikki Ahern, announced that the first round of 2017 CMS program audit notices will be sent starting February 21 for early April audit start dates.

The 2016 Civil Monetary Penalties List

Recently, CMS announced the 17 Medicare Advantage (MA) plans subject to civil monetary penalties (CMPs) based on their 2016 audit findings. Until this year, the months of February and March in the MA space meant the application season.

The Future of Medicare Advantage Provider Directory Requirements

Through their first round of Medicare Advantage (MA) online directory audits, CMS has made it clear to health plans they will continue to aggressively identify and pursue instances of noncompliance by using a host of oversight methods. The results from the first round identified significant errors and many of the findings suggest that, at a minimum, there will be increased frustration from members and may significantly prevent access to care.

Part D Drug Spend: Reimbursements

Prescription Drug Event (PDE) records are the official records used by the Centers for Medicare & Medicaid Services (CMS) for Part D revenue reconciliation, coverage gap discount payments, STAR measures, 1/3 financial audits, and CMS program audits.