In July, the Centers for Medicare & Medicaid Services (CMS) introduced two pivotal updates that health plan administrators need to be aware of to maintain compliance with the latest regulations.
Welcome to the first installment of our blog series, Open Enrollment Readiness: Expert Insights from HealthAxis. This series is designed to provide health plans with valuable real-world insights and practical advice as they prepare for the critical open enrollment period. Our thought leaders at HealthAxis will share their expertise on key areas that can make or break your open enrollment success.
The healthcare industry faces a constant challenge: balancing rising costs with the imperative to deliver high-quality care. Prior authorization has become a crucial tool for payers, helping to ensure medical necessity and control spending. However, the current process is often bogged down by administrative complexities, creating a burden for both providers and patients.
The Centers for Medicare & Medicaid Services (CMS) introduced the Medicare Prescription Payment Plan (M3P) as a part of the Inflation Reduction Act of 2022. It represents a significant shift in the Medicare landscape, offering Medicare Part D enrollees a new way to manage the cost of their prescription drugs. While this initiative aims to alleviate financial burdens for beneficiaries, it also introduces complexities for health plans.
Welcome to the first installment of HealthAxis InFocus, a video series where we share insights and perspectives from our leaders based on our interactions with clients, prospects, and industry experts.
As healthcare payers and third-party administrators (TPAs) gear up for the open enrollment period (OEP) and annual enrollment period (AEP), ensuring a smooth and successful process is paramount. With increased volumes of inquiries, transactions, and member interactions, preparation is crucial.
In the intricate realm of healthcare, healthcare organizations confront the daunting challenge of adhering to stringent regulations. Non-compliance can precipitate severe financial penalties, erode trust, and impair operational efficacy. Understanding these risks is paramount for maintaining the equilibrium of financial stability and reputational integrity.
The 2024 Medicare Advantage and Part D Final Rule (CMS-4201-F) introduced new constraints on Utilization Management (UM) policies, particularly prior authorization, effective January 1, 2024. CMS aims to assess UM-related performance for plans covering 88% of beneficiaries this year through routine and focused audits. From client discussions, I have noted that these UM-focused audits show no sign of slowing down and have ranged from basic to quite extensive, emphasizing the need for thorough preparation.
Traditionally, prior authorization has been a complex, time-consuming process fraught with inefficiencies. Disconnected systems and manual procedures not only slow down care but can also lead to significant administrative errors. These challenges have long plagued healthcare payers, providers, and members, creating barriers to timely and effective care.
The McGuireWoods Healthcare Private Equity & Finance Conference remains a premier event that convenes healthcare industry leaders to explore innovative strategies for growth and success. As CEO of HealthAxis, I had the privilege of speaking on the panel “Investing in Healthcare IT/Payor Services for a Digital Future” at the 20th anniversary of the event on Thursday, June 9, 2024.