When you need a Medicare Advantage expert…
Given the myriad of available managed care resources, it can be daunting to sift through the options and determine who is best qualified to develop solutions for your Medicare Advantage and Part D challenges. Just as you would not trust your mother’s triple bypass procedure to a general surgeon, nor should you trust your Medicare Advantage or Part D program to anyone without years of relevant experience and impeccable credentials. MCS can help make that process easier.
How does one identify a Medicare Advantage or Part D expert? Many consultants claim to be “Medicare experts,” but look under the hood a little more closely. Which part of the Medicare program do they have experience with, and how long have they worked in that area? Medicare as a whole is a vast and highly complex federal program. If there isn't significant experience directly with the Medicare managed care program (Medicare Advantage and its predecessors) over the years, chances are good that resource does not have the expertise needed to adequately assist you. Hiring someone with years of NCQA experience to develop your Medicare QA program will not necessarily result in a compliant program. Hiring someone who worked at CMS for years in the Medicaid space will do more harm than good for your Medicare Advantage program; Medicare and Medicaid are vastly different programs and are not a substitute for each other.
Can the consulting group you're considering offer both widely knowledgeable Medicare experts as well as MA or Part D subject matter experts (SMEs)? Medicare experts should be complemented by a team of veteran subject matter experts who know an aspect of the Part C or D program inside and out. A well-rounded team of Part C and D experts and SMEs provide a holistic approach, focusing both on operational details as well as the bigger picture.
The team at MCS is comprised entirely of bona fide Medicare Advantage and Part D experts, as well as dedicated SMEs in many areas of the programs. Every one of our consultants has spent anywhere from ten to almost thirty years exclusively in the Medicare managed care field, either working for Medicare health plans or with the Centers for Medicare and Medicaid Services (CMS). Every MCS project has benefited greatly from the dual approach of industry and regulatory experience. In addition to having the broad range of experience that entitles us to call ourselves Medicare experts, we each have specialized areas of expertise, from applications, appeals and grievances to compliance to enrollment and disenrollment, Prescription Drug Plan (Part D) Services to training as well as many others.
We carefully compile our project teams to meet the specific needs of each client and each project with the subject matter expertise needed for that engagement. Call us to discuss the exact resources your organization needs.