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Medicare Solutions |
| Recent legislation has created new opportunities and issues for populations covered by Medicare and the health plans serving them. The growing ranks of elderly adults and retirees are prompting myriad new challenges for many industry segments. Reden & Anders offers a comprehensive line of Medicare consulting services, actuarial tools, and data to help you navigate this critical area including financial/marketplace feasibility analyses, CMS filings, reimbursement/premium strategies, and medical expense utilization and cost benchmarking. |
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Services & Tools:
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ASC Calculator
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The Reden & Anders ASC Calculator translates the various reimbursement allowances by the Medicare ambulatory surgical category (ASC) groupings into a single average reimbursement allowance per outpatient surgical encounter. |
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CMS Audit Preparation & Review
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Reden & Anders CMS Audit Preparation & Review products help you prepare for Centers for Medicare and Medicaid Services (CMS) onsite audits of performance and CMS compliance. |
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CMS Policies & Procedures
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Maintaining current policies and procedures that are compliant with the ever-changing CMS rules and guidance can be an overwhelming task for Medicare Advantage plans. Rely on the expertise of Reden & Anders consultants to assist you. |
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Excess-of-Loss Rating Model
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The Reden & Anders Excess-of-Loss Rating Models develop excess-of-loss premium rates for various populations with two tools; the Hospital Model calculates rates for hospital-only and global coverages and the Physician Model calculates rates for professional coverages. |
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Ingenix Health Technology Pipeline
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This management tool is one of the few publicly available sources of information that contains both a comprehensive identification of developing health technologies as well as a projected cost impact and suggestions for operational adjustments to minimize costs. It combines the clinical information in the pipeline with financial forecasts so you can anticipate your future medical expenses and plan accordingly. |
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Inpatient Charge Profile
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The Reden & Anders Inpatient Charge Profile, developed from the Centers for Medicare & Medicaid Services (CMS) MEDPAR data, provides information on billed charge levels by Major Diagnostic Categories (MDC) codes. Historical information is provided for multiple calendar years, with annual trends conveniently summarized. |
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Medical Expense Benchmarking & Analysis
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With margins razor thin in the increasingly competitive health care market, it is important for health plans, insurers, and at-risk providers to understand how their experience compares to realistic and achievable industry benchmarks. |
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Medicare 5% Sample
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The Reden & Anders Medicare 5% Sample Experience Trend Reports provide information on utilization, charge, Medicare allowed per service, and per member per month expense for service categories provided at the facility or by physicians. |
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Medicare Advantage Application & Implementation
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Since the mid 1980s, our highly experienced team of consultants has assisted scores of clients with Medicare managed care applications. We bring a multi disciplinary team to these engagements—clinicians, management consultants, actuaries, and professionals with expertise in administration, marketing, sales, compliance, provider relations, and other areas. |
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Medicare Advantage Bidding Services
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Reden & Anders has expertise gained from assisting more than 100 Medicare Advantage and Prescription drug Plan contractors prepare their annual bid proposals to submit to CMS. Typically, these projects begin in January and are completed in early June to meet CMS submission deadlines. |
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Medicare Advantage Financial Feasibility
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Reden & Anders helps you financially evaluate Medicare Advantage products. A typical Reden & Anders financial feasibility study includes actuarial estimates of medical expenses; administrative costs, including product launch, marketing, and sales; enrollment projections and timing; and pro forma financial projections for possible new products. |
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Medicare Advantage GAP Analysis
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Reden & Anders has extensive experience with the managed Medicare market and knowledge of the Medicare program and Medicare Modernization Act. With this knowledge, Reden & Anders can help you assess Medicare Advantage plan capabilities and challenges that you may have in implementing a Medicare Advantage product. |
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Medicare Advantage Provider Contracting
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Reden & Anders can assist you with Medicare Advantage provider contracting. With tools specifically developed to model reimbursement as a percent of Medicare reimbursement, Reden & Anders can help you measure the affect of changing provider contracts.
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Medicare Advantage Services
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Reden & Anders Medicare Advantage services cover an array of needs, including feasibility, strategy, applications, and preparation and filing of Medicare Advantage bids. We also offer services for Medicare Advantage prescription drug plans and special needs plans (dual, institutionalized, and chronic care). |
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Medicare Consulting Services
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Legislation has created new opportunities and issues for people and populations covered by Medicare. We offer a comprehensive line of consulting services, actuarial tools, and data to help you leverage this critical area. |
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Medicare Part D Reporting
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Reden & Anders can provide a comprehensive analysis of your Medicare Part D experience and provide you a Medicare Part D Management Report that is extracted from the Reden & Anders’ Medicare Part D Reporting Tool. |
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Medicare Retiree Drug Subsidy Collection
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In order to collect the Medicare Retiree Drug Subsidy, you must submit the required data to Centers for Medicare and Medicaid Services. Reden & Anders can help you with submission of the necessary data as well as help you compile the information needed in order to facilitate collection of the Medicare Retiree Drug Subsidy. |
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Physician Charge Forecaster
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The Reden & Anders Physician Charge Forecaster, developed from the Medicare 5% Sample data, provides information on billed charge trends for specific codes and groupings of CPT codes for 35 specialties. |
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Trend Analysis
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Reden & Anders assists you with both measuring historical trends as well as forecasting trends. Our actuaries take great care to identify the drivers of historical trends, including information on demographic mix and utilization and unit costs by service categories. Reden & Anders can implement all of the Ingenix products, including the Ingenix Health Technology Pipeline and predictive modeling techniques, to identify emerging technologies and the actuarial affect on costs. |
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Questions?
To discuss how we can help your organization, please contact us:
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info@reden-anders.com or
(800) 765-6042 |
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