Coventry Health Care just recognized Extend Health for efficiency and customer satisfaction, including zero customer complaints in 2011. Here’s a brief snip from the press release.

“Extend Health Inc., a leading provider of health benefits management services, including the nation’s largest private Medicare exchange, received two first place awards from Bethesda, Maryland-based Coventry Health Care, Inc. (NYSE:CVH) for exceptional customer service performance by a partner in 2011.

  • Zero customer complaints reported to the Centers for Medicare and Medicaid Services (CMS) by seniors signing up for Coventry private Medicare supplement plans through Extend Health;
  • The lowest 90-day plan cancellation rate — called rapid disenrollment — which, at just 0.5 percent, was far less than the typical rate.”

Click here to read the complete news release.

Visit Extend Health to use the ExtendExchange™ platform – the nation’s largest private Medicare exchange.

Based on provisions in the Affordable Care Act, over the last two years CMS has stepped up its efforts to root out and prevent Medicare fraud with measures that include stronger penalties, enhanced provider screening and enrollment requirements, improved fraud prevention coordination and new high tech tools. This post takes a look at the success of those efforts so far.

Anti-fraud efforts by the Health Care Fraud Prevention and Abuse Control (HCFAC) recovered over $4 billion during 2011, and nearly $11 billion over the past three years. In February of 2012 the Medicare Fraud Strike Force busted a $375 million health care fraud scheme, arresting a Dallas area doctor, office manager, and five owners of home health agencies for their alleged participation.

Other accomplishments include:

  • Charged 323 defendants who allegedly billed Medicare for over $1 billion
  • Charged 1,430 defendants with health care fraud and convicted 743
  • Recovered approximately $2.4 billion under the False Claims Act (FCA) in 2011

Seniors on Patrol Against Fraud

CMS is bringing seniors into the effort to control fraud too. In November of 2011 CMS awarded $9 million to the Senior Medicare Patrol (SMP) program to help it continue the fight against Medicare fraud. The SMP program has 5,000 volunteers across the nation. The funds will help seniors learn how to prevent, detect, and report health care fraud.

According to CMS, “the SMP volunteers work in their communities to educate Medicare beneficiaries, family members, and caregivers about the importance of reviewing their Medicare notices, and Medicaid claims if dually-eligible, to identify errors and potentially fraudulent activity.”

Since the program began in 1997, more than 25 million people have participated in community outreach education events, and over 4 million Medicare beneficiaries have received education in one-on-one counseling sessions.

High-Tech Tools

In 2011 CMS added high-tech tools to help it “crack down on waste, fraud and abuse.” In June of 2011 CMS announced that it would begin using predictive modeling technology, similar to technology used by credit card companies, to identify potentially fraudulent Medicare claims and prevent them from being paid. The new tools will help CMS move from its former “pay & chase” approach to one that focuses on preventing fraud and abuse before it takes place.

Visit Extend Health to use the ExtendExchange™ platform – the nation’s largest private Medicare exchange.

The 2012 Medicare Trustees Report released today echoes last year’s report estimating the Hospital Insurance Trust Fund (Medicare Part A) will stay solvent until 2024. The Medicare Board of Trustees issues this report annually and it has been projecting the year the program would become insolvent almost every year since the reports began back in 1970. A recently published chart  lists the projections from previous reports.

The 2012 report also says that premiums and revenue for Supplementary Medical Insurance program (Medicare Part B and Part D) are expected to cover costs.

The CMS press release and link to the report are available here.

Visit Extend Health to use the ExtendExchange™ platform – the nation’s largest private Medicare exchange.

Join us to learn how AGL Resources, Inc., reduced retiree health insurance costs and provided retirees with benefits of equal or better value by leveraging a Medicare exchange.

During this webcast you will learn:

  • How AGL Resources was able to provide its retirees with more choice and better value for their health care dollars.
  • How AGL Resources reduced OPEB liabilities, simplified administration, and made retiree health care benefits sustainable.
  • Details of AGL Resources’ decision making process, communication protocol and keys to success.

Register today!

Webinar Details:

April 11, 2012
10:00 am PST/1:00 pm EST

Featuring:

Chasity Miller
Managing Director, Compensation & Benefits
AGL Resources, Inc.

Richard K. Wheeler
Senior Vice President
Extend Health, Inc.

Visit Extend Health to use the ExtendExchange™ platform – the nation’s largest private Medicare exchange.

On Monday, March 12th the Department of Health and Human Services Center for Consumer Information and Insurance Oversight (CCIIO) released a set of final regulations that will govern the state-based health insurance exchanges created by the Affordable Care Act (ACA). The much-anticipated regulations will allow states to further their efforts to create marketplaces where individuals and small employers can purchase health insurance starting in 2014. What will the setup of these state-based health care exchanges mean for Extend Health clients? In this interview, our resident health care reform expert and Director of Product Marketing, John Barkett, who worked on drafting and implementing the ACA before coming to work at Extend Health, helps translate what’s going on.

Extend Health: What’s the difference between a state-based health care exchange and the ExtendExchange Medicare exchange platform operated by Extend Health? Are they the same thing?

John Barkett: They are not the same thing. The state-based exchanges and the ExtendExchange platform are both marketplaces where carriers can list their products and individuals can shop for and enroll in a plan. The New York Stock Exchange serves the same purpose for firms who wish to list and sell securities and investors who wish to buy them. But the state-based health care exchanges also have the power and responsibility to qualify plans. This is similar to how the SEC must certify a firm before it is permitted to sell its shares on a stock exchange. The regulations that were just released are 644 pages long (Download), in part because states are being tasked with setting up an insurance-world equivalent of both a stock exchange and a securities exchange commission for health insurance.

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As employers consider alternatives to offering retirees traditional group Medicare insurance, they may evaluate more than one supplemental insurance solution. Employers often compare an Employer Group Waiver Plan (EGWP) solution with a private Medicare exchange such as the one provided by Extend Health. Both solutions offer some clear benefits, including:

  • Financial relief provided by CMS subsidies
  • GASB and FAS liability reductions
  • Catastrophic payment relief
  • Increased benefit flexibility

However, only a Medicare exchange can reduce an employer’s administrative burden, and only a Medicare exchange can provide post-65 retirees with the flexibility to choose a supplemental plan that meets their needs, often at a lower cost. These are solid reasons to move to a Medicare exchange solution, but employers with certain populations, such as unions that have strong contractual benefits obligations, may prefer not to migrate their full Medicare-eligible population to an exchange.

Understanding that both solutions offer advantages for employers, Extend Health has partnered with Medco to provide an Extend Health EGWP solution. Employers can leverage the power of the individual Medicare marketplace through the nation’s largest private Medicare exchange, recognize savings, and meet ongoing obligations to retain a group prescription drug program where necessary.

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