On December 30, 2019, the Centers for Medicare & Medicaid Services (CMS) announced updates to the Parts C & D Enrollee Grievance, Organization/Coverage Determination and Appeals Guidance, which became effective as of…
Rejected Claims Review: Just As Important As Ever In 2019
Are you confident in your current process to review and identify non-compliant rejected claims? Rejected claim analysis is a year-round activity with special emphasis that should begin before January. As a Plan…
2020 Star Ratings Spotlight
CMS’ release last week of the 2020 Star Ratings gives us our first glimpse into the most recent performance data for Medicare Advantage plans across the nation. The 2020 Star Ratings show…
2020 Readiness Checklist
On October 3, 2019 the Centers for Medicare & Medicaid Services (CMS) released the 2020 Readiness Checklist highlighting critical operational and contractual requirements for Medicare Advantage Organizations (MAOs), Prescription Drug Plans (PDPs),…
Blending Network Strategy & Product Strategy
As more and more health systems and provider organizations successfully manage the shift from volume-based patient care to value-based population health management, health plan strategic planning should be blending network strategy with…
Three Ways to Retain Your Members for 2020
It’s the Annual Election Period (AEP) and now is a really difficult time to turn your thoughts away from what’s right in front of you, but a strong retention program can be…
Compliant Coding and Documentation: Minimize Compliance Risk with CMS through HCC audit programs
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…
