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February 2017 Compliance Insights

February 2017 Compliance Insights

IMPORTANT REMINDERS

February 9, 2017: Issuance of Revised Integrated Denial Notice (Form CMS 10003-NDMCP)

CMS issued a revised OMB-approved standardized Notice of Denial of Medical Coverage (or Payment), also known as the Integrated Denial Notice (IDN). Medicare health plans, including Dual Eligible Special Needs plans (DSNPs), issue the IDN to inform enrollees of their appeal rights, as applicable, for paymentor service denials and for discontinuation or reduction of a previously authorized course of treatment. These plans should begin using the revised IDN as soon as possible, but no later than Ap ril 10, 2017.


February 23, 2017: Contract Year (CY) 2017 Draft Program Audit Protocols for Medicare-Medicaid Plans (MMPs)

The purpose of the memo is to provide MMP’s an opportunity to comment on the 2017 Draft Audit Protocols for MMP’s. The Draft Audit Protocols for MMPs are designed to ensure compliance with three-way contract requirements in the following areas:

  • Medicare-Medicaid Plan Care Coordination & Quality Improvement Program Effectiveness (MMP-CCQIPE) Program Area
  • Medicare-Medicaid Plan Service Authorization Requests, Appeals and Grievances (SARAG) Program Area

Comments should be submitted by March 9, 2017 to the Medicare-Medicaid Coordination office at: MMCOCapsModel@cms.hhs.gov.

UPDATE: March 3, 2017

CMS is extending the comment period for the Contract Year (CY) 2017 Draft Program Audit Protocols for Medicare-Medicaid Plans (MMPs). In the memorandum and attachments, released on February 23rd, we requested comment by March 9th. CMS is now extending that comment period to 8pm Eastern on March 16th. Comments should be sent to MMCOCapsModel@cms.hhs.gov.

February 24, 2017: Updated Complaints Tracking Module (CTM) Standard Operating Procedures

CMS released a comprehensive memorandum on the Complaints Tracking Module (CTM) updating the Standard Operating Procedures. Remember on March 18, 2017, CMS will launch a redesigned CTM to introduce improvements to the module’s user interface and functionality. For clients using MedHOK’s CTM platform, a separate communication will be sent directly to you regarding the enhancements.

COMPLIANCE NEWS

February 1, 2017: 

CMS released the Advance Notice of Methodological Changes for Calendar Year (CY) 2018 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2018 Call Letter with no significant changes. Some of the highlights of this year’s draft letter include

  • Expected Rate Hikes and Quality Bonus
  • Encounter Data Phase-In Frozen
  • Risk Adjustment Model Changes
  • Star Announcements
  • Accounting for poor audit results in Star
  • Data Integrity
  • Tiering exceptions

Please see our 2018 Call Letter Rather Humdrum; But No Signals Away From Value-Based Purchasing blog on this subject.

February 28, 2017: Registration Open: CMS’ 2017 MA & PDP Spring Conference & Webcast & MA and PDP Audit & Enforcement Conference & Webcast Announcements

Registration is now open for the annual CMS 2017 MA & PDP Spring Conference & Webcast & MA and PDP Audit & Enforcement Conference & Webcast Announcements. This all-day event will be held on Wednesday, May 10, 2017 from 9:30 AM – 4:30 PM EDT as CMS provides important information for MA organizations and Part D sponsors. Continuing education credits are available for this conference. CMS does not charge a conference fee. Session topics include:

  • Auto-Forwarding Coverage Determination Cases to the Independent Review Entity (IRE AF) – Policy, Monitoring and Compliance Panel
  • Summary of Benefits Discussion
  • Medicare Advantage Organization Performance on CAHPS Measures
  • Provider Directories Review Update
  • Care Coordination in Medicare Advantage—A Panel Discussion

To register for this webinar, visit the webcast registration at CMS 2017 MA & PDP Spring Conference (Webcast).

SECURITY NEWS

As The Hacker News published on February 22, 2017, a new scam is targeting Google Chrome users. Hackers are able to insert a Java script into websites that are poorly secured and modify the text, which makes the site appear to the user to have random characters, symbols and jumbled text. The user is prompted to update their “Chrome font pack”, which is actually installing a malware trojan on the computer. The scam can also be used to infect the computer and hold it hostage unless a “ransom” payment is made to release your files back to you.

Marc Ryan

Marc S. Ryan serves as MedHOK’s Chief Strategy and Compliance Officer. During his career, Marc has served a number of health plans in executive-level regulatory, compliance, business development, and operations roles. He has launched and operated plans with Medicare, Medicaid, Commercial and Exchange lines of business. Marc was the Secretary of Policy and Management and State Budget Director of Connecticut, where he oversaw all aspects of state budgeting and management. In this role, Marc created the state’s Medicaid and SCHIP managed care programs and oversaw its state employee and retiree health plans. He also created the state’s long-term care continuum program. Marc was nominated by then HHS Secretary Tommy Thompson to serve on a panel of state program experts to advise CMS on aspects of Medicare Part D implementation. He also was nominated by Florida’s Medicaid Secretary to serve on the state’s Medicaid Reform advisory panel.

Marc graduated cum laude from the Edmund A. Walsh School of Foreign Service at Georgetown University with a Bachelor of Science in Foreign Service. He received a Master of Public Administration, specializing in local government management and managed healthcare, from the University of New Haven. He was inducted into Sigma Beta Delta, a national honor society for business, management, and administration.

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