CMS, Plans Face Huge Hurdles, Deadlines As They Attempt to Reconcile 2006 Payments, Medicare Part D Compliance News ReportsWASHINGTON, June 11, 2007 — While CMS is optimistic that it can wrap up Medicare prescription drug benefit payment reconciliation for 2006 plan sponsors by September, some plans say the process has been “more disastrous” than they first anticipated, especially with regard to premium withholding reconciliation, reports Atlantic Information Services, Inc.’s Medicare Part D Compliance News (PDN). Due to computer errors, in September and October 2006 some beneficiaries who opted to have premiums withheld from their Social Security checks did not have their premiums deducted from their checks properly. In November CMS told plans it had resolved 65% of the premium issues and had sent the remaining 35% to the Social Security Administration (SSA) to clean up. According to one industry insider interviewed by PDN, the SSA premium withholding problems in 2006 have had a “trickle down effect [that has] been abysmal.…CMS just gave SSA a lump sum [of money] and said ‘fix it,’” the source contended. According to that source, this resulted in “some beneficiaries with huge amounts of money that they shouldn’t have.” When CMS first implemented Part D, the agency thought there would be two reconciliations needed to determine plan payments — risk adjustment and Part D payment reconciliation. But that was before the implementation issues. Now, according to Tom Hutchinson, acting director of the Medicare Plan Payment Group at CMS, the agency is faced with plan-to-plan and state-to-plan Prescription Drug Event (PDE) data reconciliation, and enrollment and premium withholding reconciliation. This article excerpt is from the June issue of Medicare Part D Compliance News, a monthly newsletter, which addresses Part D compliance issues as they relate to marketing, enrollment, formularies, rebates, claims pricing, and fraud, waste and abuse. The article can be viewed in its entirety at http://www.aishealth.com/PressReleases/pdn0607_pr.pdf. Other stories featured in this issue include:
These articles along with other news and data from the June issue of Medicare Part D Compliance News can be accessed in PDF format at http://www.aishealth.com/PressReleases/pdn0607_pr.pdf. Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for 20 years. It develops highly targeted news, data and strategic information for managers in hospitals, managed care plans, medical group practices, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, looseleafs, books, strategic reports, databases, audioconferences and live seminars. Visit http://www.aishealth.com/ CONTACT Atlantic Information
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