Discusses the reasons Medicare marketing must be high on the list of compliance officer in a managed care organization offering a Medicare+Choice product. Permissible and impermissible marketing and promotional activities; Handbook that covers most of the rules on marketing materials and promotional ...
Medicare/Health-Plans/ManagedCareMarketing/FinalPartCMarketingGuidelines. Plans may provide provider and/or pharmacy directories electronically without prior consent from an enrollee. Part D plans may (1) send enrollees the plan formulary in hard copy, which may be abridged, or (2) send a distinct...
The other type of broker—field marketing organizations (FMOs), or field brokers—generally deliver a smaller proportion of D-SNPs but stronger retention. E-brokers and FMOs are both caught in the disconnect between the need for retention and payers’ imperatives to grow the D-SNP cohort, ...
Limited, standardized, licensure requirements would lower practitioner expenses, promote mobility, ease national marketing, and help the profession grow. It sounds great — as good as tuna smells to a cat. Does it make you make you want to come running? Many changes in licensure requirements coul...
On Dec. 11, 2024, the OIG issued a Special Fraud Alert (Alert) related to certain fraud and abuse risks associated with marketing arrangements between Medicare Advantage Organizations (MAOs) and health care professionals...more Tick-Tock: CMS Overpayment Refund Final Rule and Practical Implications...
marketing, care quality and outcomes, value-based care arrangements and equity and vertical integration. Other areas CMS is interested in learning more is prescription drug plans, individuals dually eligible for Medicare and Medicaid, people with end stage renal disease (ESRD) and MA marketing practic...
2.43 “Operations Manual” means the BLUE CROSS SENIOR SECURE PARTICIPATING MEDICAL GROUP Operations Manual, which is hereby incorporated by reference herein. 2.44 “Other Payor” means persons or entities utilizing the Managed Care Network pursuant to a contract with BLUE CROSS, including without limit...
Reasonable cost plans (or cost plans) are Medicare managed care plans that are reimbursed by Medicare for the actual cost of providing services to enrollees. Cost plans were created in the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA; P.L. 97-248). BBA97 included a provision to...
regardless of the plan the beneficiary enrolls in.”13With customer acquisition costs widely pushing north of $2,000 across the country, these compensation caps could—if implemented as proposed—have a meaningful impact on the financial solvency of the largest field-marketing organizations and ...