Best Practices to Face Medicare Eligibility Challenges
Author: Jordan Battani
The cost and compliance pressures faced by Medicare Advantage and Medicare Part D plans today create more incentive than ever to lower costs, maximize revenue, improve beneficiary eligibility service and ensure regulatory compliance. Private Medicare plans that implement Medicare best practices in the three key process areas of enrollment, Medicare eligibility updates and reconciliation can enhance their performance by increasing premiums and reducing costs.
The Global Institute for Emerging Healthcare Practices is the applied research arm of CSC’s Healthcare Group.
In recent years, private Medicare plans have faced increasing scrutiny around cost and compliance, leading some beneficiaries to question the value of their private health plans and increasing the number and intensity of health plan audits. Recent analysis predicting near-term bankruptcy for the entire Medicare program and research demonstrating that private Medicare plans are more costly than traditional Medicare suggest that continued pressure on rates for private Medicare plans is a virtual certainty.1,2 These forces challenge Medicare Advantage and Medicare Part D plan profitability, and make operational efficiency and revenue optimization more critical than ever.
This paper discusses the steps that Medicare plans can take to address the unique Medicare challenges in maintaining Medicare beneficiary eligibility information amid complex coordination requirements with the Centers for Medicare and Medicaid Services (CMS).
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