On January 30, 2019, the Centers for Medicare & Medicaid Services (CMS) released Part II of its Advance Notice of Methodological Changes for Calendar Year (CY) 2020 for Medicare Advantage (MA) Capitation…
It’s the Most Wonderful Time of the Year…To Think About Your 2019 CPE Audit
For most Plan Sponsors, the holidays are not a time of respite or reflection; they are a time for looking forward to the upcoming calendar year. This is when Compliance begins its…
CMS Proposed Rule Addresses Rx Pricing in Medicare Advantage and Part D
The Centers for Medicare & Medicaid Services (CMS) released detailed and specific requirements on November 20, 2018, in the “Part D Drug Management Program Policy Guidance.” The release includes the “how to”…
OEP – Avoiding Membership Loss Due to Buyer’s Regret
My father was hospitalized a few years ago and then readmitted a few days later. A few weeks later when I was checking in with him, he told me he had to…
Key Components in Shared-Risk Pool Reporting
When a team works well together, the members collectively accomplish more than any of the individuals could have accomplished alone. Certainly we have proven that adage true in healthcare as can be…
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…
