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Enrollment reconciliation is a front-end process that affects all other calculations. Errors in enrollment will lead to errors in claims processing, improper Prescription Drug Event (PDE) transaction calculations, and financial risk for receiving incorrect prospective subsidy payments. It also puts health plans squarely within CMS’s compliance crosshairs due to the impact on beneficiaries. Now CMS has told plans that activities such as “yearly clean-ups” are too infrequent and not acceptable practices. Plans violating CMS requirements are at risk of being audited and facing corrective action plans, penalties, and/or sanctions. Strategies that automate the enrollment process can help plans with real-time enrollment and/or disenrollment of members, load batch enrollment files more frequently, maintain enrollment history and complete audit trails of all data changes, and generate Part D enrollment submission files, among other things. They will also help plans stay in compliance by allowing for easier testing of their enrollment processes, regular monitoring of their enrollment systems to detect errors, and the creation of reports based on monitoring. Hear three experts in Part D enrollment reconciliation provide specific guidance on how to automate your enrollment processes, including strategies for providing real-time enrollment and disenrollment at the point of service. These strategies will ensure that your enrollment processes are in compliance with CMS requirements to reduce your chances of large potential penalties and bad publicity, as well as save time and money. Topics covered include:
Erin Costell, managing partner at Global Pharmaceutical Solutions (GPS), has seven years experience in health care benefits consulting and administration, providing Part D consulting services to corporate plan sponsors, governmental agencies, Taft-Hartley trusts, stand-alone Prescription Drug Plans, and Medicare Advantage prescription drug plans. Prior to joining GPS, Costell was a consultant at Buck Consultants, where she helped develop the firm’s Medicare consulting efforts and supported the delivery of Medicare services to clients nationally. Marye Issacs, senior consultant at GPS, was an original member of the Employer Policy and Operations Group at CMS, where she played a major role in developing CMS policies regarding all types of employer- and union-sponsored prescription drug plans, including the Retiree Drug Subsidy program and the Employer Group Waiver Program. Her duties include evaluating legislation and program issues and assessing the feasibility of policies to determine the effectiveness of the programs. Julian Nadolny, senior consultant at GPS, has over nine years experience in the health care insurance field. Prior to joining GPS, he was a member of the Employer Policy and Operations Group at CMS, where he played a key role in developing and implementing the Employer/Union-only Group Waiver Plan program. He has in-depth knowledge of payment, benefit, and formulary design; non-calendar-year plans; enrollment; pharmacy access; and low-income premium subsidy pass-through requirements. Moderator: Barbra Golub, JD, editor of Medicare Part D News.
Compliance officers, auditors, legal counsel, government-relations executives, financial executives, program managers, provider-relations managers, and other managers with Part D responsibilities at:
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Listeners will also receive practical written information to supplement information covered by the audioconference speakers.
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