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CMS REPORTS MEDICARE ADVANTAGE
PROVIDER DIRECTORIES CONTINUE TO BE PLAGUED WITH INACCURACIES
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The Centers for Medicare & Medicaid Services
(CMS) issued its Year Two online provider directory review of
Medicare Advantage plans – the results were dismal and actually got
worse in the last year.
“Nearly half of all directory locations reviewed were inaccurate,
ranging from 11% to 97.82%,” noted Elena
Martin, Gorman Health Group’s (GHG’s) Senior Director of
Provider Strategies. “CMS noted the lack of internal auditing and
testing remains a compliance gap.”
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ADVANCE NOTICE UPDATE
- RISK ADJUSTMENT
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Now
that Part II of the Advanced Notice and Call Letter has been
released, we are able to get a full view of the proposed policy
changes to pave the way for the future.
“The
crux of risk adjustment changes were included in the Part I
release,” said Jessica
Smith, GHG’s Vice President of Risk Adjustment &
Healthcare Analytics.
In
a new article, Jessica identifies the high-level proposed policy
changes from Part I and Part II impacting risk adjustment.
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THE IMPORTANCE OF
ACCURATE DATA UNIVERSES
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Whether you are from a health plan or a first tier,
downstream, and related entity, data universes are critical to your
organization’s success.
“CMS imposes strict penalties and fines when health plans cannot
produce data – $25,000 for an invalid data submission (IDS) per
violation/contract. IDS issues, if identified, can also have a
negative impact to a health plan’s Star Ratings,” explained Tina
Bailey, GHG’s Senior Director of Compliance
Solutions.
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POLICY UPDATES
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Stay
connected to industry news and gain perspective on how to navigate the
latest issues.
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HOUSE PASSES SPENDING BILL THAT INCLUDES MANY MEDICARE
ADVANTAGE POLICIES; SENATE ANNOUNCES TWO-YEAR BUDGET DEAL
On Tuesday, the House passed a bill that would fund the government
through March 23, 2018. Meanwhile, the Senate leaders announced
Wednesday afternoon they have reached an agreement on a two-year
spending deal.
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UPCOMING EVENTS
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Stay connected to industry news and gain perspective
on how to navigate the latest issues. Full list of events here.
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JOBS
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Gorman Health Group is always looking for leading
professionals in the healthcare industry to further enhance our team
of experts.
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