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Claims
Compliance Analyst Exercise
1. A claims management employee
is seeking clarification of the 2023 Part B Rebatable Drug Coinsurance
Adjustment under the Medicare Inflation Reduction Act (IRA).
Please
compose a 1-page explanation in your own words that includes the following:
·
A
summary of this provision of the IRA law for Part B Drugs processed under the
medical benefit.
·
Implementation
time frame
·
Cost
Share impact for members
·
Impact
and/or benefit configuration changes MetroPlusHealth, as a Medicare Advantage Plan
(Part C) , must make to be in compliance with the Law
o
What
information will MetroPlus Health Plan have available to make any needed changes?
·
Anything
else from the law for this provision you think is relevant for the Claims team
to know/understand
Please include
references or links to the regulations used to create your write up.
Please take the Metroplus doc and reformat it to make it look like a professional memo to Claims Team. Please keep all in-text citations and condense all of the information onto one page without omotting content.
Please ensure that the explanation is easy to follow and understand as well.
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