This document discusses Meijer's use of a dependent eligibility verification audit to address rising healthcare costs. It outlines the reasons for the audit, which were rising costs and ensuring compliance. The process involved communicating the audit, verifying dependents' eligibility through documentation, and escalating any issues found. This controlled process helped lower spending by removing ineligible dependents from coverage. As a result of the audit, Meijer confirmed many eligible dependents and identified some ineligible ones, putting them in a good position to maintain accurate records going forward and avoid large-scale audits.
7 common causes of denials and how to prevent themjennyvergeese
There is no denying that claim denials can prove to be a major headache for medical practices. Denials not only have a negative impact on the cash flow but also affect practice efficiency. Wondering what is causing denials at your practice?
A combination of case study and infographic, this piece uses the experience of a specific practice to flesh out both the challenges of the healthcare landscape, and Greenway’s ability to help meet those challenges.
Improve Employee Health & Control Healthcare Costs with Direct Primary CareMegan Zimmerman
Direct Primary Care is providing employers of all sizes substantial cost savings while improving health outcomes. Learn how telemedicine, occupational health, wholesale medications, direct labs and imagining are working in tandem to create a cost effective and proactive healthcare model for employers.
Why Orthopaedic Surgeons Should Get Involved in Political AdvocacyJeremy Burnham
This brief presentation outlines reasons for political advocacy, the downfalls of ignoring advocacy, and some recent successes that resulted from orthopaedic surgeons taking the lead in public advocacy.
The Patient Experience and Its Impact on Your Health Practice and ProfitabilityBen Buchanan
In our most recent webinar in coordination with Availity, we covered the journey of the patient experience for health professionals. Here’s what we cover:
- Who is today’s patient? What are their expectations? What is patient satisfaction?
- Uncovering the cost difference between generating new patients versus retaining an existing one.
- 5 steps practices can implement to maximize the patient experience thus contributing to the overall profitability.
For more information on healthcare payment processing, learn more here: https://bit.ly/2O9mvDV
Jay Keese: Breaking the Status Quo in Washington D.C.Hint
Jay Keese, Executive Director of the Direct Primary Care Coalition, will talk about the changing tides of healthcare reform in Washington D.C. and provide insights into the new Direct Care pilots being discussed for Medicare.
[Infographic] The Healthcare CFOs’ Outlook for Real Estate in 2014JLL
JLL surveyed CFOs from a range of major healthcare systems - check out their thoughts on real estate trends in 2014. See more on how your healthcare system can use these trends to its advantage at http://bit.ly/1idmdDr
7 common causes of denials and how to prevent themjennyvergeese
There is no denying that claim denials can prove to be a major headache for medical practices. Denials not only have a negative impact on the cash flow but also affect practice efficiency. Wondering what is causing denials at your practice?
A combination of case study and infographic, this piece uses the experience of a specific practice to flesh out both the challenges of the healthcare landscape, and Greenway’s ability to help meet those challenges.
Improve Employee Health & Control Healthcare Costs with Direct Primary CareMegan Zimmerman
Direct Primary Care is providing employers of all sizes substantial cost savings while improving health outcomes. Learn how telemedicine, occupational health, wholesale medications, direct labs and imagining are working in tandem to create a cost effective and proactive healthcare model for employers.
Why Orthopaedic Surgeons Should Get Involved in Political AdvocacyJeremy Burnham
This brief presentation outlines reasons for political advocacy, the downfalls of ignoring advocacy, and some recent successes that resulted from orthopaedic surgeons taking the lead in public advocacy.
The Patient Experience and Its Impact on Your Health Practice and ProfitabilityBen Buchanan
In our most recent webinar in coordination with Availity, we covered the journey of the patient experience for health professionals. Here’s what we cover:
- Who is today’s patient? What are their expectations? What is patient satisfaction?
- Uncovering the cost difference between generating new patients versus retaining an existing one.
- 5 steps practices can implement to maximize the patient experience thus contributing to the overall profitability.
For more information on healthcare payment processing, learn more here: https://bit.ly/2O9mvDV
Jay Keese: Breaking the Status Quo in Washington D.C.Hint
Jay Keese, Executive Director of the Direct Primary Care Coalition, will talk about the changing tides of healthcare reform in Washington D.C. and provide insights into the new Direct Care pilots being discussed for Medicare.
[Infographic] The Healthcare CFOs’ Outlook for Real Estate in 2014JLL
JLL surveyed CFOs from a range of major healthcare systems - check out their thoughts on real estate trends in 2014. See more on how your healthcare system can use these trends to its advantage at http://bit.ly/1idmdDr
6 revenue cycle metrics you must be tracking nowango mark
Learn how you can improve the financial performance year on year. Leverage your practice revenue cycle metrics by setting benchmarks & KPIs for your billing department - http://bit.ly/2hwlqpm
With more than three decades of experience in law, Kelly Testolin practices out of Reno, NV, where he primarily aids health care groups. Moreover, attorney Kelly Testolin gives presentations on legal matters related to health care, such as his May 2013 discussion Accountable Care Organizations under the Patient Protection and Accountable Care Act.
Understanding Fraud, Waste and Abuse for Long Term Care and Adult Family Home is becoming increasingly more complex. Learn more to protect your residents and providers.
“Regulatory Compliance Enforcement Update: Getting Results from the Guidance” PYA, P.C.
PYA Principal and Chief Compliance Officer Shannon Sumner and Consulting Senior Manager Susan Thomas presented “Regulatory Compliance Enforcement Update: Getting Results from the Guidance” at the virtual 2020 Montana Healthcare Conference. They reviewed the sources of regulatory enforcement and investigation information—guidelines, statutory updates, best practices, settlements, case studies, etc.—available to healthcare organizations. They will also discuss how to interpret and implement the guidance in order to strengthen the compliance function and protect the organization. The presentation covered:
Compliance regulatory requirements for healthcare organizations.
Guidance available for consideration in organizational compliance programs.
Internal and external reporting to ensure regulatory requirements are met.
Best practices for implementation of guidance.
Case studies for illustration of guidance implementation.
Chapter 16: Managing
Information
Chapter Objectives
• Appreciate the interconnected nature of
computerized devices in hospitals and other
organizations.
• Be able to define and explain the elements of an
electronic health record system.
• Appreciate the growing use of information systems
in support of public health activities.
• Understand that many health care providers and
members of the public do not share the same
enthusiasm for information systems that managers
have.
Outline
• Electronic Health Records
• Managing Public Health Information
• Managing Inventory
• Managing Human Resources
Definitions
• Health Information and Data
• Result Management
• Order Management
• Decision Support
• Electronic Communication and Connectivity
• Patient Support
• Administrative Processes
• Reporting
Health Information and Data
• Provide immediate access to information such
as individual diagnosis, medications, allergies,
and laboratory test results to improve the
ability or service to make sound clinical
decisions in a timely manner.
Result Management
• Provide access to new and past test results,
thus allowing all participating providers to
make more informed decisions about the
effectiveness of treatment regimens and
patient safety.
Order Management
• Ensure that providers have the ability to enter
and store orders for prescriptions, tests, and
other services. This capability is intended to
improve legibility, reduce duplication, and
allow orders to be completed in a timely
manner.
Decision Support
• Provide reminders, prompts, and alerts to
facilitate diagnoses and treatments by
improving compliance with best clinical
practices, promoting regular screenings and
other preventive practices, and identifying
possible drug interactions.
Electronic Communication and
Connectivity
• Promote secure, open, and readily accessible
channels of communication among providers
and patients to improve the continuity of care,
increase the timeliness of diagnoses and
treatments, and reduce the frequency of
adverse events.
Patient Support
• Provide tools that give individuals access to
their health records, provide interactive
education on relevant health topics, and
protocols to help people conduct home-
monitoring and self-testing activities to
improve control of chronic conditions such as
diabetes and hypertension.
Administrative Processes
• Include computerized administrative tools,
such as scheduling and record-keeping
systems; such equipment should greatly
improve the efficiency and performance of
hospitals and clinics, allowing them to provide
more timely services to patients and other
clientele.
Reporting
• Provide sufficient supportive equipment
(software, hardware, and memory capacity)
that meets uniform data standards and
enables health care organizations to respond
more quickly to federal, state, and private
reporting requirements, including those .
The below stated are the Challenges and business requirements faced .pdfapleather
The below stated are the Challenges and business requirements faced by the hospital
Population health
Population health was one of the biggest ideas in healthcare this past year, and it will likely
maintain or gain momentum in the next few years to come. But despite the frequent use of the
term in the healthcare bubble, population health is a multidisciplinary concept to be shared
between public health agencies, social institutions and policymakers.
Hospitals fit in there somewhere. Defining that role is one of the ongoing challenges they will
face in 2015.
Hospitals\' demand for population health expertise overwhelms the supply. Nearly 60 percent of
health system and hospital CEOs ranked population health as the hardest skill set to find within
the broader healthcare field, according to a 2014 American Hospital Association survey. Further,
nearly half of executives polled identified community and population health management as a
talent gap within their organizations. Some health systems are filling this gap by creating new C-
suite positions: 10 percent of executives indicated their health system had a chief population
health manager.
Quantifying population health is another challenge. Although healthcare leaders need to think
creatively about how to improve the health of a geographic population, they should also maintain
a healthy sense of skepticism about population health efforts. What might seem like a much-
needed intervention on paper, such as a grocery store in a food desert, may be one small piece of
a multipronged solution. There are no silver bullets, after all. Amid excitement for population
health, systems may oversimplify problems and overinvest in solutions only to see the same
health outcomes.
To find success, hospital leaders may need to diminish their traditional reliance on \"programs\"
and instead focus more on partnerships with community organizations and nonprofits. Some
health systems still act as autonomously as they can, ignoring a wealth of expertise and
resources.
\"When we talk to other population health managers, they have unearthed a number of unique
challenges inside their populations, such as domestic violence, elder abuse and other public
health crises,\" says Jason Dinger, PhD, CEO of MissionPoint Health Partners in Nashville, the
accountable care organization affiliated with Saint Thomas Health. \"Unfortunately, most
respond by trying to implement their own unique program to respond to the issue. We usually
encourage them to first speak with the experts in their community who work on these issues
every day. In many cases these are nonprofit organizations that can add great value to the
population health effort but often have trouble engaging and integrating with a health system\'s
efforts.\"
Shifting from volume- to value-based reimbursement
The move from volume- to value-based reimbursement is inevitable. For now, it\'s a matter of
how quickly providers should make it.
Move too fast, and hospitals risk los.
6 revenue cycle metrics you must be tracking nowango mark
Learn how you can improve the financial performance year on year. Leverage your practice revenue cycle metrics by setting benchmarks & KPIs for your billing department - http://bit.ly/2hwlqpm
With more than three decades of experience in law, Kelly Testolin practices out of Reno, NV, where he primarily aids health care groups. Moreover, attorney Kelly Testolin gives presentations on legal matters related to health care, such as his May 2013 discussion Accountable Care Organizations under the Patient Protection and Accountable Care Act.
Understanding Fraud, Waste and Abuse for Long Term Care and Adult Family Home is becoming increasingly more complex. Learn more to protect your residents and providers.
“Regulatory Compliance Enforcement Update: Getting Results from the Guidance” PYA, P.C.
PYA Principal and Chief Compliance Officer Shannon Sumner and Consulting Senior Manager Susan Thomas presented “Regulatory Compliance Enforcement Update: Getting Results from the Guidance” at the virtual 2020 Montana Healthcare Conference. They reviewed the sources of regulatory enforcement and investigation information—guidelines, statutory updates, best practices, settlements, case studies, etc.—available to healthcare organizations. They will also discuss how to interpret and implement the guidance in order to strengthen the compliance function and protect the organization. The presentation covered:
Compliance regulatory requirements for healthcare organizations.
Guidance available for consideration in organizational compliance programs.
Internal and external reporting to ensure regulatory requirements are met.
Best practices for implementation of guidance.
Case studies for illustration of guidance implementation.
Chapter 16: Managing
Information
Chapter Objectives
• Appreciate the interconnected nature of
computerized devices in hospitals and other
organizations.
• Be able to define and explain the elements of an
electronic health record system.
• Appreciate the growing use of information systems
in support of public health activities.
• Understand that many health care providers and
members of the public do not share the same
enthusiasm for information systems that managers
have.
Outline
• Electronic Health Records
• Managing Public Health Information
• Managing Inventory
• Managing Human Resources
Definitions
• Health Information and Data
• Result Management
• Order Management
• Decision Support
• Electronic Communication and Connectivity
• Patient Support
• Administrative Processes
• Reporting
Health Information and Data
• Provide immediate access to information such
as individual diagnosis, medications, allergies,
and laboratory test results to improve the
ability or service to make sound clinical
decisions in a timely manner.
Result Management
• Provide access to new and past test results,
thus allowing all participating providers to
make more informed decisions about the
effectiveness of treatment regimens and
patient safety.
Order Management
• Ensure that providers have the ability to enter
and store orders for prescriptions, tests, and
other services. This capability is intended to
improve legibility, reduce duplication, and
allow orders to be completed in a timely
manner.
Decision Support
• Provide reminders, prompts, and alerts to
facilitate diagnoses and treatments by
improving compliance with best clinical
practices, promoting regular screenings and
other preventive practices, and identifying
possible drug interactions.
Electronic Communication and
Connectivity
• Promote secure, open, and readily accessible
channels of communication among providers
and patients to improve the continuity of care,
increase the timeliness of diagnoses and
treatments, and reduce the frequency of
adverse events.
Patient Support
• Provide tools that give individuals access to
their health records, provide interactive
education on relevant health topics, and
protocols to help people conduct home-
monitoring and self-testing activities to
improve control of chronic conditions such as
diabetes and hypertension.
Administrative Processes
• Include computerized administrative tools,
such as scheduling and record-keeping
systems; such equipment should greatly
improve the efficiency and performance of
hospitals and clinics, allowing them to provide
more timely services to patients and other
clientele.
Reporting
• Provide sufficient supportive equipment
(software, hardware, and memory capacity)
that meets uniform data standards and
enables health care organizations to respond
more quickly to federal, state, and private
reporting requirements, including those .
The below stated are the Challenges and business requirements faced .pdfapleather
The below stated are the Challenges and business requirements faced by the hospital
Population health
Population health was one of the biggest ideas in healthcare this past year, and it will likely
maintain or gain momentum in the next few years to come. But despite the frequent use of the
term in the healthcare bubble, population health is a multidisciplinary concept to be shared
between public health agencies, social institutions and policymakers.
Hospitals fit in there somewhere. Defining that role is one of the ongoing challenges they will
face in 2015.
Hospitals\' demand for population health expertise overwhelms the supply. Nearly 60 percent of
health system and hospital CEOs ranked population health as the hardest skill set to find within
the broader healthcare field, according to a 2014 American Hospital Association survey. Further,
nearly half of executives polled identified community and population health management as a
talent gap within their organizations. Some health systems are filling this gap by creating new C-
suite positions: 10 percent of executives indicated their health system had a chief population
health manager.
Quantifying population health is another challenge. Although healthcare leaders need to think
creatively about how to improve the health of a geographic population, they should also maintain
a healthy sense of skepticism about population health efforts. What might seem like a much-
needed intervention on paper, such as a grocery store in a food desert, may be one small piece of
a multipronged solution. There are no silver bullets, after all. Amid excitement for population
health, systems may oversimplify problems and overinvest in solutions only to see the same
health outcomes.
To find success, hospital leaders may need to diminish their traditional reliance on \"programs\"
and instead focus more on partnerships with community organizations and nonprofits. Some
health systems still act as autonomously as they can, ignoring a wealth of expertise and
resources.
\"When we talk to other population health managers, they have unearthed a number of unique
challenges inside their populations, such as domestic violence, elder abuse and other public
health crises,\" says Jason Dinger, PhD, CEO of MissionPoint Health Partners in Nashville, the
accountable care organization affiliated with Saint Thomas Health. \"Unfortunately, most
respond by trying to implement their own unique program to respond to the issue. We usually
encourage them to first speak with the experts in their community who work on these issues
every day. In many cases these are nonprofit organizations that can add great value to the
population health effort but often have trouble engaging and integrating with a health system\'s
efforts.\"
Shifting from volume- to value-based reimbursement
The move from volume- to value-based reimbursement is inevitable. For now, it\'s a matter of
how quickly providers should make it.
Move too fast, and hospitals risk los.
Health Datapalooza 2013: Health Data Consortium Affiliates - Sunnie Southern,...Health Data Consortium
Health Datapalooza IV: June 3rd-4th, 2013
Health Data Consortium Affiliates: Igniting Around Health Data in Your Community
Moderator:
Dwayne Spradlin, Chief Executive Officer, Health Data Consortium
Speakers:
Sunnie Southern, Founder and Chief Executive Officer, Viable Synergy, LLC and Innov8 for Health
Colorado: Phil Kalin, Center for Improving Values in Health Care (CIVHC)
Louisiana: Ramesh Kolluru, NSF Center for Visual and Decision Informatics (CVDI)
New York: Dave Whitlinger, New York eHealth Collaborative
The Health Data Consortium Affiliates have spent the past year rallying their communities around health data. Leaders from each affiliate will discuss how they have liberated data at the state and local levels and how they have seeded data with local entrepreneurs and application developers to build solutions. If you are interested in working on health data in your region, this is the panel for you. (And the Affiliate network is now accepting applications!) Whether hosting a state-level Datapalooza, setting up a new incubator, or just hosting local meet-ups, representatives from affiliates will answer your questions about what has worked well and what can be improved.
Health Care "Prime" - The Future of the Ownership, Organization, Payment, and...Polsinelli PC
The potential for disruption and disaggregation of traditional and incumbent players is occurring across the health care ecosystem and care continuum, and may accelerate through the intended and unintended consequences of this innovative new venture. Is this partnership a seminal event in defining the future of health care? Author William Gibson said, “The future is already here – it’s just not very evenly distributed.” This statement applies as the future of health care fast approaches, but with variability across stakeholders, their businesses, and the communities in which they provide care as part of one of America’s largest industries.
A diverse panelist group will bring a broad range of current perspectives and insights related to this partnership. From the base of the panelists’ unique perspectives, they will discuss their views on the likely near-, mid- and long-term implications of this announced venture on the ownership, organization, payment, and delivery of health care products, supplies and services in America.
The Personal Finance and Nutrition and Wellness teams of the Military Families Learning Network will be joining together to present this 90-minute webinar that will focus on the crossover effect of positive health behaviors and positive financial behaviors. As Drs. Ensle and O’Neill will discuss, research has found a strong correlation between health and wealth. This webinar will discuss those correlations and ways to motivate clients to adopt positive behaviors in both parts of their lives.
2. Today I will discuss 2 The Reasons The Process The Solution
3. Rising Healthcare Costs 3 Hewitt Associates, comp. Meijer and Hewitt: Partnering for Success-Appendix-Historical Healthcare Costs and Trends. Rep. Hewitt Associates, 2010. Print. Hobson, Katherine. "Is Your Spouse Really Your Spouse? A Dependent Audit Wants to Know - Health Blog - WSJ." WSJ Blogs - WSJ. June-July 2010. Web. 29 July 2010. Fuller, Thomas J. "RealLife HR Recommends Cost-Savings Tool: Dependent Eligibility Audit - Benefits & Compensation - HR Management US | GDS Publishing." HR Management | The Online Human Resources News Source HR Management | The Online Human Resources News Source | GDS Publishing. Web. 03 Aug. 2010. <http://www.hrmreport.com/article/RealLife-HR-Recommends-Cost-Savings-Tool-Dependent-Eligibility-Audit/>.
4. Dependent Eligibility Audit? Highly Structured Controlled Process Helps lower health care spending Mitigates Compliance/Fiduciary violations 4 HRAdvance - Benchmarking Case Studies." HRAdvance's Plan-Smart: The Standard in Eligibility Solutions. Web. 28 July 2010. <http://www.plan-smart.com/ppt/dea_results_stats.html>.
6. Reasons for the Dependent Eligibility Verification Audit: 6 Rising cost HealthCare Expansion Audit presents a two-fold solution Confirm Eligible Dependents RemoveIneligible dependents
7. 7 Executive Summary Meijer’s use of a dependent eligibility verification audit has enabled them to: Ensure that current team members comply with health plan eligibility requirements. Develop a process that allows them to avoid future large scale eligibility audits.
15. Cost Savings 15 * Estimate, subject to change by audit’s conclusion. Hobson, Katherine. "Is Your Spouse Really Your Spouse? A Dependent Audit Wants to Know - Health Blog - WSJ." WSJ Blogs - WSJ. June-July 2010. Web. 29 July 2010. "Dependent Eligibility Audits Impacted by Reform Law." SHRM Online - Society for Human Resource Management. Web. 02 Aug. 2010.
19. HCR Results 19 As of July 26th 508 Dependents added 340 have provided accurate proof 21 have provided inaccurate proof
20. With this process in place…. Meijer is able to ensure that their records remain accurate, avoiding the need to “clean house” with another large scale dependent eligibility verification audit in the future. 20
I am Louis Lawson, and as an intern in the Total Rewards department, I worked on the Dependent Eligibility Verification Audit.
Today I will be discussing the reason for the audit, the process of the audit, and the solution put in place to avoid a company dependent eligibility audit in the future.
Over the past five years, Meijer has seen a steady increase in health care cost This graph shows that Meijer’s budget for health care per employee per year has increased year on year for the past five years at an average of 5.7%. There appears to be no end in sight, according to a recent report from PriceWaterhouseCoopers health care cost are expected to increase by 9% in 2011. With this being the case, it is ideal for Meijer to take all possible measures to mitigate health care spending, According to the publication HR Management: Given the rise in healthcare costs, and practically every option to curb healthcare spending exhausted,Many companies are now turning to dependent eligibility audits to effectively qualify the benefits they provide to their employees and their dependents.
A dependent eligibility audit is a highly structured systematic, independent, and documented process for obtaining evidence. Subscribers who claim dependents on their health plans are required to submitofficial record(s) that prove each dependent is eligible under the criteria defined by Meijer’s health plan.This is a controlled process designed to preserve the integrity of an employer’s benefit plan by identifying incorrectly enrolled participants. Incorrectly enrolled and ineligible dependents can result in significant and unnecesary cost to the plan sponsor and participants, as well as, create compliance/fiduciary violations on the part of the employer. An audit helps to lower cost and mitigate compliance/fiduciary violations such as ERISA Fiduciary duty (only pay benefits to eligible team members and dependents) and sarbanes-oxley (strenghten internal financial controls and reporting) by confirming the eligibility of each dependent on an employer’s plan.
A DEVA’s success is based on two factors:The percentage of team members who verify the eligibility of their dependents, thus confirming their compliance with Meijer’s health plan requirements. The percentage of dependents that are unable and unwilling to verify their eligibility and are required to forfeit coverage through Meijer, translating to lower health care cost for Meijer.
I have discussed the need for companies to perform an audit in general, but why exactly did meijer decide to implement one?For the past six years, like most companies, Meijer has not required their team members to provide proof that their dependents are eligible for coverage. Given the rising cost of health care over the past five years and health care expansion, a dependent eligibility verification audit provides a two- fold solution to meijer:Allows the employer to ensure that all dependents are eligible and in full compliance with Meijer’s plan requirementsIt provides a forum where ineligible dependents can be taken off the employer’s plan lowering overall costs
Through working on Meijer’s dependent eligibility verification audit I have concluded that :Meijer’s use of an audit has not only enabled them to ensure that current team members comply with health plan requirements but also has allowed Meijer to develop a process that allows them to avoid future large scaled eligibility audits through the practice of requiring documentation for each dependent added to a team member’s coverage.
Now that we know why Meijer decided to do a Dependent audit, lets discuss the actual process of the audit.
After an extensive Request for Proposal Process, where several vendors vied for meijer’s business. We decided upon Mercer, a leading Human Resources consulting firm, who specializes in dependent eligibility verification audits. One of their selling points, was their ability to adapt to Meijer’s requirements. Time constraints were one of the biggest challenges that Meijer faced during the audit. Given the timeframe and desire to complete the audit before open enrollment, We at Meijer required a timeline of 16 weeks total and only 8 weeks for employee verification. Typically an audit is 24 weeks with a verification period of 16 weeks. Mercer was so tasked with verifying the eligibility of our team members’ 18,175 dependents in 16 weeks.
The most important part of an eligibility audit is the communication process, our strategy was to provide our team members with as much notice and information as possible. This began with targeted letters that preceded their audit package.These letters were segmented into two groups.Team members with and without dependentsTeam members with dependents were informed of the upcoming audit, Meijer’s partnership with Mercer, and Meijer’s decision to become an early adopter of the expanded eligibility to age 26 courtesy of the Patient Protection and Affordable Care Act.Letters to team members without dependents were distributed in order to make them aware of the expanded eligibility,in the event that they had dependents that were newly eligible because of the PPACA. As an early adopter, we allowed team members to add their newly eligible dependents starting mid June through July 30th. In addition to developing targeted letters, myself and Colleen worked with Mercer to modify their verification packet. During this task, I drew upon my experience as a customer service rep on an audit for the State of New York, working along with the DEVA team we were able to meijerize and modify the documents sent by Mercer in order to mitigate confusion and expedite cooperation.Upon beginning the audit, a decision was made to reinforce the communication sent via mail with articles posted in the company newsletter. Our decision was to increase the urgency of these messages as the deadline approached.
A great deal of time was placed on the initial communications to help expedite cooperation during the document verification process. As seen above, the process is quite simple. The team member received a packet with instructions on what to provide to prove their dependents eligibility. Compliance with those instructions resulted in a completion notification. If documents were not sufficient, the team member would receive an incomplete notification, and if they did not respond they would receive a non responder notification. Beyond explicit instructions. A call center staffed by Mercer in Toronto, has been available to clarify any issues for our team members. Once the documents are sent in and complete. An auditor determines whether a dependent is confirmed as eligible or ineligible for coverage. If the documents prove eligibility, a complete status letter is issued and the dependent is confirmed eligible If the documents do not prove eligibility, the dependent is currently ineligible and an incomplete status letter is issued.The audit process also allows team members to voluntarily remove ineligible dependents. A team member is able to submit documentation up to August 17th to prove their dependents eligibility. If proof is not submitted by this date, the team member’s dependents will be dropped.
Even with explicit instructions and a trained customer service staff, there are always unanticipated scenarios. As the intern for this project, I was responsible for handling issues that were escalated pass the csr and escalation manager at Mercer. Some of which included accommodating individuals that had not filed their taxes yet. I made the decision, based upon my experience that the 2008 tax return along with the 2009 tax extension would be acceptable proof as one example. Another example is the Affidavit of parentage, we received a string of 9 team members submitting this document, after doing research on the legitimacy of this document and consulting Mark Henderson at Mercer, we made the decision to accept this document as proof of relationship for child dependents.
Upon receipt of documents from team members, the results are posted onto our DEVA site.This site provides real time reporting and access to a spreadsheet for each metric being recorded. I have converted the data on this page into a pie graph for clarity. This pie graph provides a breakdown of our 9,803 team member’s status, whether they have completed the process, are in process, incomplete, or have not started at all. At this point there are 82.8% that have completed the process.
Once the process is complete the team member’s dependents are determined eligible or ineligible. This page provides real time reporting of the status of our team member’s 18,174dependents. As you can see _83.2%__ of our dependents are eligible and .3% are in progress While 2.5% of our dependents are currently ineligible because they have been removed or have failed verification. 14% to date have not provided documentation. These three groups represent the cost savings of an eligibility audit.
Before health-care overhaul legislation passed, Mercer estimated that between 3% and 8% of covered family members wouldn’t be able to back up that claimed relationship with proof.The ppaca act effected the age limitation of dependents, according to HRAdvance (now with Hewitt and Associates)President Craig Firestone,Children age 19 and older make up approximately one-third of the total ineligible dependents in our current eligibility audits, he estimates that the number of ineligible overage dependents will be reduced from 3.3 percent of the total population to an average of 1.5 percent, based on student status now being irrelevant,Overall, Firestone expects that the number of ineligible dependents will drop by about 4 to 5 percent compared to pre-reform levels.Meijer began planning for this audit prior to the law change, needless to say, the cost savings projections that were anticipated have been reduced.According to Mercer, the average cost of an ineligible dependent is $2100, in order to determine the savings that come from removing an ineligible dependent one simply has to multiply the amount of ineligible dependents by $2100.To date, ____dependents have been removed from this verification, roughly___%, this translates to an annual savings of $____ and five year savings of $____.This amount does not include the ___ who have not provided documents, this ___accounts for roughly ____ dependents, upon August 17th, the percentage that has not provided documents must also be included in the cost savings calculations. We project that the annual savings will be higher because of this.
We know why the audit was done, and how it was done, what are we doing here at Meijer to avoid implementing another audit of this scale.
Moving forward, Meijer wishes to avoid such global dependent audits as the one currently underway. In order to do so, the shared services team developed a process that requires team members to provide proof of their dependent enrollees within sixty days. Team Members will receive a notice at the midpoint, enrollees will be dropped if proof is not submitted. I worked directly with the file team to develop a process for uploading that proof into Meijer’s system.
The above flow chart diagrams the process of receiving proof. This process has been piloted for the HCR process, which is Meijer’s early adopter of the PPACA expanded eligibility initiative. Proof is received, if it is invalid it is distributed to HRSS CSRs in order to follow up with the team member to acquire valid proof. If the proof is valid, it is given to the file team, who logs this information into the PeopleSoft system, based upon the process myself and Dave Webber in shared services developed. This process will be used during open enrollment for new enrollees and people dropped from coverage due to their inability to provide proof of eligibility.
Meijer’s decision to be an early adopter of the PPACA has generated 508 Dependents, the team member who enrolled this dependent is given the sixty days to provide proof. If proof is not provided by that time, the dependent is terminated from coverage. To date 340 dependents have been officially added to coverage based upon accurate proof provided subsequent to their enrollment. 168 are still pending (including the 21 responses with inaccurate proof) accurate documentation to verify eligibility.
Given increasing Health Care cost and expanded eligibility of dependents through health care reform and the patient protection and affordable care act in particular, this process ensures that Meijer will offer health care to only those who have proven their eligibility, thus avoiding another company-wide dependent eligibility audit in the future.