Contact us to know about the new policies issued by CMS 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
HTTPS://WWW.247MEDICALBILLINGSERVICES.COM/
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 more>>

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
HTTPS://WWW.247MEDICALBILLINGSERVICES.COM/
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.

4. CMS Issues New Policies to Provide
Greater Transparency for Medicare
Advantage and Part D Plans
HTTPS://WWW.247MEDICALBILLINGSERVICES.COM/
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.

5. CMS Issues New Policies to Provide
Greater Transparency for Medicare
Advantage and Part D Plans
HTTPS://WWW.247MEDICALBILLINGSERVICES.COM/
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.

6. CMS Issues New Policies to Provide
Greater Transparency for Medicare
Advantage and Part D Plans
HTTPS://WWW.247MEDICALBILLINGSERVICES.COM/
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.

7. About Us
HTTPS://WWW.247MEDICALBILLINGSERVICES.COM/
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.

8. Contact Us
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