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Health Plan News & Insights

Are you prepared for a
CMS audit?

If The Centers for Medicare and Medicaid Services (CMS) walked through your door today and asked to audit your health plan, would you be prepared? Unfortunately, for many Medicare Advantage and prescription drug plans, the answer is “no.” Yet, with CMS continuing to crack down on compliance violations, this hypothetical audit could very well become a reality.
With Annual Enrollment Period (AEP) material preparations now in the critical final stages, the timing of these audits could be particularly bad for health plans that are not prepared. Tight resources could delay the distribution of member materials, putting your plan at risk of incurring additional compliance violations and hefty fines.

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Expert Q&A: Douglas Pray,

Director, CodyPrint

Q: We missed the print date for our ANOC and EOC materials. What do we do?    
A: Assuming your printer cannot reschedule you within a reasonable timeframe, the first thing you should do is look for a new HIPAA-compliant printer to print these materials. At the same time, be thinking about a backup plan for your fulfillment and lettershop vendors, since these timelines will also be delayed.
Health plans should have materials assembled and in the mail no later than September 17 in order to meet the September 30 deadline. However, if this is not possible, you will need to mail materials via First-Class Priority or Priority-Express Mail. To better prepare for next year, consider developing a contingency plan that outlines what to do in these instances.
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Now Offering: Document Accuracy Assessments

If you’re like most health plans, you could use an extra week in the ANOC and EOC creation schedule and a few extra sets of eyes during the content review process. With the complexity of building these materials, document errors can occur easily. In fact, a CMS audit of 2014 plan documents showed that 86% of EOCs and 14% of ANOCs contained errors. 
Don’t let that be you! Our Document Accuracy Assessment services provide a thorough review of your plan benefit information. We can help your team identify inconsistencies and errors in your materials that could negatively impact members and cause CMS to take action against your plan.
Contact us today for more information.


Modern Healthcare contributor Bob Herman discusses why moving the Affordable Care Act risk-adjustment program to a Medicare Advantage model may be difficult in Should ACA risk adjustment be more like Medicare Advantage?
In CMS Identifies Hospitals Paid Nearly $1.5B In 2015 Medicare Billing Settlement, Kaiser Health News reports which hospitals are expecting a payday after the recent Medicare billing resolutions.
FierceHealthcare editor Gienna Shaw discusses how the upcoming Presidential election could impact the Affordable Care Act in 2016 election and the future of the Affordable Care Act: End of the road?


Did you know that CMS distributed 496 HPMS memos to health plans in 2015? That’s a 45% increase from 2013. With anywhere from 10 to 20 HPMS memos distributed each week, there’s a heavy burden on compliance departments to review, interpret and respond to these documents – and doing so properly doesn’t always happen.
The CodySoft® HPMS Memo Module™ helps streamline the review, organization and response to HPMS memos issued by CMS. When integrated with the Regulatory Analyzer®, the HPMS Memo Module can also attach relevant HPMS memos to the underlying rules and regulations that they impact.
We help government-funded and commercial health plans maximize efficiencies, reduce risk and experience savings by streamlining marketing communications and regulatory compliance issues.
CodySoft® is a revolutionary suite of web-based software products designed specifically for health plans and their complex environment.
Copyright © 2016 Cody Consulting Group, Inc., All rights reserved.

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