On Tuesday, December 4, 2018, the Centers for Medicare & Medicaid Services (CMS) released a Health Plan Management System (HPMS) memo addressing updates for the 2019 Program Audit Process. The biggest surprise?…
Patients Over Paperwork is Real
CMS is advancing an initiative they call ‘Patients Over Paperwork”. We are all busy people and don’t always pay close attention to slogans and platitudes coming from the government. But as the…
The Future of RADV and Compliant Data Submissions
The latest proposed regulations released at the end of October were more of a reminder to heath plans of the Risk Adjustment Data Validation (RADV) regulations already in place rather than a…
Preparing Your Care Management Team for Optimal Performance
As many plans are preparing to write a new Model of Care (MOC) for a new service area, an expanded service area, or redlining or revising an existing document, many plans miss…
CMS MA Proposed Rule: Star Ratings Updates
Last week, the Centers for Medicare & Medicaid Services (CMS) released a Proposed Rule allowing expanded access to telehealth services for Medicare beneficiaries, streamlining appeals processes for beneficiaries in Dual Eligible Special…
Medicare Advantage 2020 Proposed Rule
It’s been a long wait since the passage of the Bipartisan Budget Act in February, but the 2020 Medicare Advantage (MA) proposed rule is finally here. Perhaps the biggest opportunity for plans…
Inside MA-PD Premium Trends
With the release of the 2019 landscape files, benefit information and Star Ratings data, now is the time to update your market analyses to understand trends in your current and potential markets.…
