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CMS Issues New Policies To Provide Greater Transparency For Medicare Advantage And Part D Plans

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Title: CMS Issues New Policies To Provide Greater Transparency For Medicare Advantage And Part D Plans


1
CMS Issues New Policies to Provide Greater
Transparency for Medicare Advantage and Part D
Plans
The Centres for Medicare and Medicaid Services
(CMS) are coming up with new policies to bring
reforms in the healthcare industry. It is
heralded as the final rule which aims at
providing improved and better transparency for
Medicare Advantage and Part D plans. The new
policies of the 2023 Medicare Advantage and Part
D Final Rule push for affordable healthcare by
reducing out-of-pocket charges for prescription
drugs. However, that advantage will be in effect
from 2024. What Does The New CMS Policy Do? The
Biden Harris administration has been committed
to offering healthcare for all with quality and
affordable care packages and this Final Rule is
the extension of that. In fact, different areas
have been worked on in the new CMS policy. Some
of them are Read moregtgt
HTTPS//WWW.247MEDICALBILLINGSERVICES.COM/
2
CMS Issues New Policies to Provide Greater
Transparency for Medicare Advantage and Part D
Plans
HTTPS//WWW.247MEDICALBILLINGSERVICES.COM/
3
CMS Issues New Policies to Provide Greater
Transparency for Medicare Advantage and Part D
Plans
Price Negotiation The finalized policy of CMS
has made it mandatory for all Part D plans to
apply concessions on the prices of the medicine
that they receive from the network of pharmacies.
The prices have to be negotiated at the point of
sale. The policy will thus reflect in
beneficiaries having the ability to share the
savings. The process also boosts price
transparency during the competition in the market
for the program of Part D. The CMS is working to
redefine the negotiated price, which will be the
baseline, or offer the lowest possible payment,
which will be effective from January 1, 2024.
Uninterrupted Service The new rule also states
that policies will allow beneficiaries enrolled
under the MA plans to have uninterrupted access
to the necessary services during emergencies and
disasters. It also covers areas like the COVID-19
pandemic.
HTTPS//WWW.247MEDICALBILLINGSERVICES.COM/
4
CMS Issues New Policies to Provide Greater
Transparency for Medicare Advantage and Part D
Plans
New Standards For Application The final rule
also adds different categories under which the
CMS can deny an application or any service
expansion application. Some of the companies'
compliances are a Star rating of over 2.5, filing
for bankruptcy, and failure to maintain the
designated thresholds given for compliance.
Medical Loss Ratio Reporting CMS is reinstating
the loss ratio reporting to promote
sustainability in the Medicare program. The
feature also re-establishes the expansion of the
reporting requirements for MA to receive
additional advantages. The whole feature will
improve the transparency of the Part D and MA
plans' and the underlying costs, which will
benefit both the taxpayers and the beneficiaries.
The medical loss ratio reporting was initially
implemented in 2014 and lasted till 2017. The
plan now requires detailed reporting on the
amount that has been spent on the different
supplemental benefits that were not available in
the original Medicare.
HTTPS//WWW.247MEDICALBILLINGSERVICES.COM/
5
CMS Issues New Policies to Provide Greater
Transparency for Medicare Advantage and Part D
Plans
HEDIS The new policy also requires CMS to
finalize the technical aspect of calculating the
2023 Part C Star Ratings. It will allow them to
collect the necessary data, which is done through
three different Healthcare Effectiveness Data and
Information Set (HEDIS). HEDIS collects the data
from the Health Outcome Survey Monitoring
Physical Activity, Bladder Control and Reducing
the Risk of Falling. Improved Coordination
Between CMS State The policies implemented in
the final rule allow better coordination between
CMS and the states. It also will enable CMS to
serve individuals better who have dual
eligibility in Medicaid and Medicare. Hence, the
process needs to have a different codifying
system that can integrate materials and plans
where dual eligibility is offered. Annual MA
Assessment Additionally, the new rule makes all
MA special needs plans assessed annually. It will
allow them to identify the social risk factors
for the individuals enrolled and their social
needs. The process is believed to be a crucial
step in offering person-centred care.
HTTPS//WWW.247MEDICALBILLINGSERVICES.COM/
6
CMS Issues New Policies to Provide Greater
Transparency for Medicare Advantage and Part D
Plans
Why Do The New Policy Changes Matter? It is
believed that many dually eligible individuals
are at much higher risk of failing to have the
security of housing, food, access to
transportation, and health literacy. In addition,
since the work of CMS is fiscal stewardship, it
needs to know where the Medicare money is used
and on which Medicare Advantage benefits. The
Final Rule has been implemented with this hope
and the ability to close the health disparities
gap with person-centred care. The policy aims to
improve the health outcomes of the individuals
enrolled by ensuring 100 reimbursement of the
services availed by them. As these changes have
direct impact on your medical billing and coding
tasks, so it is crucial to know more about it
with effect on your practice. Get in touch with
your outsourced medical billing partner, i.e.,
24/7 Medical Billing Services to know in detail.
HTTPS//WWW.247MEDICALBILLINGSERVICES.COM/
7
About Us
We are a medical billing company that offers
24/7 Medical Billing Services and support
physicians, hospitals, medical institutions and
group practices with our end to end medical
billing solutions. We help you earn more revenue
with our quick and affordable services. Our
customized Revenue Cycle Management (RCM)
solutions allow physicians to attract additional
revenue and reduce administrative burden or
losses.
HTTPS//WWW.247MEDICALBILLINGSERVICES.COM/
8
Contact Us
Media Contact 24/7 Medical Billing
Services Georgia 3001 Greenfield Drive, Marietta
GA Ohio 28405 Osborn Road, Cleveland, OH
4414030068 Texas 2028 E Ben White Blvd,
240-1030 Austin TX, 78741 Delaware 16192
Coastal Highway, Lewes, Delaware 19958, United
States Phone no / Fax 1 888-502-0537
Email us info_at_247medicalbillin
gservices.com
HTTPS//WWW.247MEDICALBILLINGSERVICES.COM/
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