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October 2013 Retiree Drug Subsidy (RDS) Community Information Group (CIG) Webinar Spotlights Part 1: What You Should Do Six Months Before Reconciliation

The Retiree Drug Subsidy (RDS) Community Information Group (CIG) hosted a webinar on Wednesday, October 30, 2013. Over 300 individuals attended the webinar allowing them to stream audio and view presentation slides.

The webinar was presented by Jennifer Craft, Manager of the Education, Training, and Outreach Division of CMS' RDS Center.

Webinar Topics:

Reconciliation Overview – "The Big Picture"

Participants were provided with an overview of the Reconciliation Process. They were introduced to the core phases of Reconciliation that included: (1) Beginning Reconciliation; (2) Finalizing Retirees; (3) Finalizing Costs; (4) Providing Payment Information; (5) Approving and Submitting the Reconciliation Request; (6) CMS' RDS Center Processing of the Reconciliation Payment Request; and (7) Maintaining Records. Participants were also introduced to the Reconciliation Checklist located on the RDS Secure Website.

The Reference Materials section of the RDS Program Website was highlighted. Participants were encouraged to explore the User Guides, Technical Articles, Job Aids, and Web-Based Trainings associated with Reconciliation.

Recommended resources related to this topic:

Assembling Your Plan and Reconciliation Team

Participants were encouraged to plan and coordinate Reconciliation activities well before initiating Reconciliation. Hosting a kick-off meeting for key players involved in the Reconciliation process was suggested. Participants were reminded to identify the User Roles required to successfully submit an RDS Application as it's important to ensure key User Roles have proper access, are registered in the RDS Secure Website, have established and maintained an active User Account by logging in every 60 days, and that they know their Security Questions and Answers.

Recommended resources related to this topic:

  • Reconciliation Toolkit - Job Aids including a Timeline, Task List, Contact List, and Best Practices
  • Authorized Representative Verification Form - Form completed by the Plan Sponsor granting legal authority to the AR binding them to the terms found in the Plan Sponsor Agreement in an RDS Application

Reviewing Retiree Electronic Data Interchange (EDI)

Participants were advised that they should review the Retiree Electronic Data Interchange (EDI) Methods and Sources on the Application to ensure the correct method and source are set to send the final retiree files. Two questions were provided for consideration: (1) Who is going to send the Final Retiree Files to CMS' RDS Center and process the Response Files for each Benefit Option and (2) Is the source different from previously sent retiree information for each Benefit Option. Plan Sponsors were also encouraged to have a copy of the Retiree Response File sent to the RDS Secure Website for monitoring purposes.

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Getting a Jump Start By Processing Retirees Now

Participants were informed that the Covered Retiree List (CRL) may be requested in advance of Reconciliation activities. To facilitate timely processing, it was suggested that Plan Sponsors not wait until Reconciliation to update the CRL. This list should be managed all year long. Plan Sponsors should request, download, and review the CRL on a regular basis - not only during Reconciliation - but throughout the Application Lifecycle as reported costs cannot include anything outside of the Qualifying Covered Retirees, Benefit Options, and Subsidy Periods listed in the CRL.

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Lining Up Your Cost Reporters

Participants were informed, figuratively, that they should "line up their Cost Reporters". What this means is (1) considering who is reporting final costs, (2) are these costs different from interim costs, (3) are there multiple Cost Reporters involved, and (4) how coordination and communication will occur. Participants were reminded that Cost Reporters are not just a source of data, but they are also a resource to assist when validating data. Communication with Cost Reporters is essential to resolving discrepancies. Plan Sponsors should be engaging Cost Reporters during the entire Retiree Management process and should be sending regular updates on the Covered Retiree List (CRL). Plan Sponsors should make sure that they are also obtaining and communicating final rebate information as this needs to be included in the final cost figures. Participants were also reminded that the person(s) that reported interim costs may not be the person(s) reporting final costs. As a result, communication is needed to ensure proper coordination of individual retiree costs data.

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Stopping Interim Payments

Participants were reminded that they cannot initiate Reconciliation when they have an Interim Payment Request in flight, and that this should be considered when putting together their plan. Plan Sponsors cannot initiate Reconciliation Step 1: Initiate Reconciliation until at least 15 calendar days have passed from the date of the last Interim Payment Determination. The Plan Sponsor should not submit an Interim Payment Request during the final 60 calendar days before the Application's Reconciliation Deadline. As a best practice, the RDS Community Information Group (CIG) recommends stopping Interim Payments 90 days prior to the Reconciliation Deadline.

Avoiding the Three Common Payment Setup Mistakes

Participants were encouraged to avoid the three common mistakes made during Payment Setup that include: (1) not assigning a Vendor to a Benefit Option; (2) not attaching Designees to a Vendor; and (3) setting up both the Plan Sponsor and Vendor to report cost data on the same Benefit Option.

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Upcoming Webinars

Participants are encouraged to attend the next RDS CIG webinar. Webinars are presented several times in the calendar year, corresponding with key Application and Reconciliation landmarks. Monitor the Events page of the RDS Program Website for announcements about upcoming webinars.

The Reconciliation Part 2: Unveiling the Mystery of Retiree Processing webinar is scheduled for November 13, 2013.

Reconciliation Part 3: Working with Cost Reporters at Reconciliation webinar is scheduled for December 18, 2013.

If you have questions or need additional information, contact CMS' RDS Center.

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