CMS Changes Network Adequacy Application Process for Medicare Advantage
NEW CMS NETWORK ADEQUACY REQUIREMENTS Demonstrate Adequate At the Time of Application 10-percentage Point Application Credit Letter of Intent to Contract CMS REINSTATES NETWORK ADEQUACY REVIEWS AS A CONDITION OF INITIAL OR EXPANDING SERVICE AREA APPLICATIONS Starting with the 2024 contract year (CY 2024) application cycle, Medicare Advantage organizations (MAOs) applying for an initial or […]
CMS to Regulate Qualified Health Plan (QHP) Network Adequacy
Starting Plan Year 2023, the Centers for Medicare & Medicaid Services (CMS) is responsible for imposing the regulations for the Qualified Health Plan (QHP) certification process, including network adequacy standards and reviews. This change was affirmed in the second final rule, HHS Notice of Benefit and Payment Parameters (also known as “2022 Payment Notice”). Specifically, changing […]
Key Application Dates: Unpacking The CMS Medicare Advantage Calendar
Centers of Medicare & Medicaid Services (CMS) Key Application Dates for CY 2022 Medicare Parts C and D Annual Calendar Our CMS calendar is one of the easiest ways to stay up-to-date with important dates and timelines for CY 2022 Medicare Advantage (MA) plans, Medicare Advantage-Prescription Drug (MA-PD) plans, Prescription Drug Plans (PDPs), Medicare-Medicaid Plans […]
Top 3 Things the “No Surprises Act” Means for Health Plans
It’s staggering to think that, according to researchers, one in five emergency room visits result in an individual receiving a bill for treatment or services they expected to be covered by their health plan, but weren’t. These unexpected, costly, and often frustrating charges are aptly called Surprise Medical Bills. While surprise medical bills impact consumers financially, […]
Designing and Building Clinician Networks That Address Social Determinants of Health
FIVE TAKEAWAYS FROM OUR WEBINAR Watch: Designing and Building Clinician Networks That Address Social Determinants of Health As clinicians and payers take on increasing risk for patient outcomes, it is essential that leaders consider the effectiveness of their networks as well as the accuracy of their clinician directories to ensure they are adequately serving their members. Modern […]
5 Things I Learned at Vision Quest
Admittedly, I’m new to provider network management. I’ve spent years working in healthcare, but this is my first time working with payers from across the nation to improve the access, adequacy, and accuracy of their provider networks. Lucky for me, I got a behind-the-scenes view through Quest Analytics Vision Quest. As a session moderator, I heard […]
New Metrics are Critical to Addressing Mental Health Access Concerns
Webinar On-Demand: Gain A Regulator’s View Into Mental Health Access Our new normal is far from normal. There is this level of incredible, nonstop uncertainty around our current situation, and none of us are immune. CDC data, collected in late June, noted an increase month-over-month in mental health issues. It showed that 40 percent of […]
The Rebirth of Network Adequacy: Modernizing Health Plan Practice
Reprinted from The URAC Report. Nearly two months ago now CMS finalized changes to Medicare Advantage (MA) and Part D for 2021 and while I previously covered the new telehealth network adequacy provisions, I’ve been meaning to do a deeper dive into how network adequacy as a whole has changed in recent years. To do this, I reached out to Cari […]
Preparing for the Era of Provider Network Transparency
Copyright 2020 Compliance Today, a publication of the Health Care Compliance Association (HCCA). Transparency is one of the top buzzwords in healthcare today. In the last few years, we have seen the rollout of significant healthcare transparency initiatives focused on portable health records, hospital costs, drug costs, quality data, and many other things (e.g., Executive […]
Rule Raises Questions About Telehealth, Directory Accuracy
Reprinted with AIS Health permission from the July 2, 2020, issue of RADAR on Medicare Advantage. As Medicare Advantage and other insurers report increasing use of telehealth during the COVID-19 pandemic and consider the larger role that virtual visits could play on a more permanent basis, CMS recently finalized a set of policies for 2021 […]