Medicare Advantage products and Medicare prescription drug plans (Part D) have provided profitable growth for many payers. However, keeping current with requirements from the Centers for Medicare and Medicaid Services (CMS) in addition to keeping products innovative and cost competitive present formidable administrative and strategic challenges for insurers.
CMS has also changed the way it monitors and enforces compliance and plans will need to be adjusted accordingly. For example:
Designing and implementing your Medicare Advantage and Part D plans requires special care so they are profitable, compliant and valuable to your members.
Our cross-functional teams bring together professionals with experience in public and private sectors who understand the stringent and complex regulations that govern how you need to design and implement your Medicare Advantage and Part D plans. We can help you with benefit design and pricing, strategic planning, preparation of applications and competitive bids, mock audit, coding audits, sales and marketing analysis, plan implementation, network development and medical management.
You should choose your vendors including pharmacy benefit managers (PBM) carefully and monitor their transactions for compliance and integrity.
We can help you with vendor oversight and accurate tracking and submission of transactions. Improved management in these areas can avoid severe financial consequences in the form of sanctions, fines and repayments.