MA Contracting
True or False: Sales Representatives are the owner of negotiations with Hospital and Ancillary Providers.
False.
What is Cigna Medicare Advantage Network Adequacy?
a measure that takes into account CMS policies and regulations as they pertain to Providers.
What is one of the 3 screening lists that Cigna uses to ensure compliance of providers?
the CMS Preclusion list, the Office of Inspector General (OIG) Exclusion List and the Medicare Opt Out list.
What is one of the steps for the Medicare Contracting Lifecycle?
Plan
Initiate
Approve
Execute
Install
Manage
What is the rarest M&M Color?
Brown
What is one goal of Contracting with Medicare Advantage Providers?
Ensure network adequacy via CMS standards or
Leverage marketability of our products to increase sales
Work closely with Network Operations and Finance to contract with groups depending on cost and industry trends with affordability in mind
Name 1 Key CMS Standards that the presentation focused on.
County classifications, time and distance, minimum provider counts, CMS Customized Time and Distance standards, Certificate of Need Credits, Exceptions, Telehealth Credits, Measured Specialties.
What tool is used to provide each market with the opportunity to determine adequacy scores in any given scenario?
Scenario Based Reporting (SBR) reporting tool/ mechanism
How long is the planning phase of the lifecycle?
12-18 months in advance of renewal date
What singer's real name is Stefani Joanne Angelina Germanotta?
Lady Gaga
True or False: One way we control costs through Medicare Advantage Contracting is through contract language.
True
What are 2 of the five county classification types?
Large Metro
Metro
Micro
Rural
County with extreme access considerations (CEAC)
when a network falls below the Minimum Provider Count Requirements AND/ OR the Health Plan’s network falls below the 85% or 90% threshold of the Time and Distance Standards for a given specialty.
Name 1 of 2 ways contract negotiation is initiated?
Cigna requests to negotiate
Provider requests to negotiate
Which NFL team holds the record for the most Super Bowl appearances?
New England Patriots
Name one of the missions of Medicare Advantage Contracting.
Work with external partners to
•Negotiate appropriate engaged relationships
•Utilization Management (UM)
•Pricing
•Terms
•All facets of business helping to improve ability to offer better benefits and higher quality outcomes to our customers
When does CMS consider a health plan adequate?
when the minimum provider counts are met AND time and distance standards are met for the specified portion, which is based on county classification.
What does CMS require a health plan to measure network adequacy against?
40 specialty types – 27 physician specialties and 13 facility specialties.
What is the Fee for Service MA Value Based contracting strategy?
•Traditional fee-for-service reimbursement, usually as a % Medicare
What are the two fruit juices in a cosmopolitan?
Cranberry and Lime
Name another goal of Contracting with Medicare Advantage Providers.
Ensure network adequacy via CMS standards or
Leverage marketability of our products to increase sales
Work closely with Network Operations and Finance to contract with groups depending on cost and industry trends with affordability in mind
Where can the time and distance standards be found for each county?
in the HSD reference file
What happens when CMS recognizes it is difficult or impossible to meet base time and distance standards given for a specific county?
CMS will customize the HSD reference file to allow for a larger radius to make it possible to become adequate in a county without the need for filing an exception request.
We offer a committed team that understands providers.
Easy to use digital solutions
TImely and accurate payment process
Competitive compensation
Actionable, patient specific information
A Medicare Five Star quality rated health plan
In what US State is it illegal to dress up as a Priest or a Nun?
Alabama