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EOB Program Optimized to Keep Pace with Changing CMS Regulations | Insurance

Senior man sitting on his sofa and working with laptop at home.

Recent changes to CMS regulations and internal goals require new thinking to address growing issues

CHALLENGE

One of the nation’s largest pharmacy benefits managers needed help to keep pace with the increasing complexity of Centers for Medicare and Medicaid Services (CMS) regulations. The original program integrated more than 40,000 printed bills and 600,000 explanations of benefits (EOBs) each month for 19 different companies.

Recent changes to CMS regulations and internal goals have required new thinking to address issues including:

  • Piece-level tracking to meet increased CMS auditing frequency
  • Versions in eight additional languages as well as Braille to meet the CMS 5% language requirement
  • Electronic EOBs to meet the client’s goal of further lowering printing costs

The client’s business and volume have grown through the years, and they have struggled to find a provider to keep up with their pace.

SOLUTION

RRD Healthcare Solutions stepped in to support them every step of the way. The partnership accommodated their growth seamlessly with multiple facilities and teams certified in healthcare-specific work. Specifically, document creation, language translations, and alternate formats for ever-changing CMS regulations were addressed.

The EOBs highlighted the strengths of RRD Healthcare Solutions. RRD stepped up as a true partner to the client, ready to support their communication strategy regardless of channel. Expert knowledge of the business was combined with digital solutions to easily convert printed communications to electronic formats.

RESULTS

Through RRD’s business communications management, this complex program launched quickly. They initially saved over $200,000 annually on postage while maintaining stringent quality and security requirements.

The program nearly quadrupled in size to over 3,000,000 pieces monthly, with annual postage savings growing to more than $1 million. In addition, RRD helped the client introduce inserts into their EOBs to support their member wellness initiatives.