Was your plan selected for this year’s Medicare Part C Contract-Level Risk Adjustment Data Validation (RADV) audit of 2014 dates of service? Have you participated in a Department of Health & Human…
The Medicare Plan Finder (MPF) Tool AND its Much Needed Make-over
Starting this AEP Medicare beneficiaries will have a new experience when researching Medicare Plans on medicare.gov. The site is much more user friendly and provides a much cleaner user experience. The picture…
Feasibility Studies
Two of the most common questions plans ask are: “Where should we be offering products?” and “What products should we be offering?” A feasibility study can really help make that picture clearer.…
CMS Seeks Comments to Proposed Audit Protocol Changes
In a Health Plan Management System (HPMS) memo dated August 20, 2019, the Centers for Medicare and Medicaid Services (CMS) announced they are seeking comments to their proposed changes to the current…
Population Health and Care Management
The term “population health” began emerging in U.S. health care circles around March 2003 when David Kindig and Greg Stoddart co-authored an article in the American Journal of Public HealthCare Management entitled…
2020 Operational Readiness Prep – Ensure Comprehensive Processes in the New Year
I was recently flying to a client site. The Southwest plane was just boarding, and I had a seat at the window in front of the engine. I was watching out the…
Wrapping Your Arms Around the Medical Benefit Drug Spend
Prescription drugs are covered through a health plan’s pharmacy or medical benefit. This determination depends on whether the drug is self-administered or given in a clinical setting. While the reimbursement process through the pharmacy…
