Topics
More on Compliance & Legal

CMS allows payers to send evidence of coverage information electronically for the first time

Regulatory changes for 2019 could save health plans up to $54 million a year, according to CMS.

Susan Morse, Senior Editor

Recent regulatory changes from the Centers for Medicare and Medicaid Services could save health plans upwards of $54 million a year in mailing costs.

In its 2019 annual notice, CMS is allowing certain insurers to share evidence of coverage information electronically, rather than mandating that the documents be printed and mailed. The EOC documents give beneficiaries details about plan coverage.

The lack of expense for printing, fulfillment and postage has the potential to save health plans millions, according to Deb Mabari, CEO of CODY, formerly Cody Consulting. In fact, according to figures from the Centers for Medicare and Medicaid Services, insurers can save $54 million.

The rule pertains to Medicare Advantage organizations, Medicare prescription drug plans and Section 1876 Cost Plans.

Until now, CMS has required health plans to jointly mail to members, by September 30, the annual notice of change and the evidence of coverage documents. 

The annual notice of change, which gives information about any changes in coverage, must still be printed and mailed, but it is a shorter document. The ANOC is still due by September 30.

But instead of being mailed together, insurers can now get the evidence of coverage documents to beneficiaries by October 15, either through the mail or by the electronic digital option. 

The added time will come with strings attached, according to  Mabari. CMS will be cracking down even harder on errors in these documents given that health plans will now have an extra two weeks to create the EOC and share them with enrollees, she said. 

The shift to electronic sharing could also have major implications for the industry as a whole. HIPAA-certified printers, whose primary source of business has been printing the EOCs, may reassess their relationships with health plans, she said.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

Show All Comments