As a former U.S. healthcare operation management professional, I understand the complexities and dynamic nature of the healthcare compliance landscape. The challenge for healthcare payers and providers is keeping up with the ever-changing regulations and integrating these changes efficiently into … Read More
Author Archives: manager.inovaare
Will Reporting Medical Loss Ratio (MLR) Constrain Payments to Medicare Advantage Plans?
Medicare Advantage plans (MAO) have been increasingly popular, with Medicare-eligible beneficiaries enrolling 51% of the eligible population in 2023, taking in $454 billion (or 54%) in Medicare spending.[1] Notwithstanding the popularity of the MA program, payments to private health plans … Read More
Regulatory Changes for PDE Reporting in CY 2024 and Beyond
On October 13, 2023, the Centers for Medicare & Medicaid Services (CMS) published the Readiness List for CY 2024. This has been a very useful tool for Medicare Advantage Organizations (MAO) to check their readiness to fulfill requirements in the … Read More
2024 Medicare Advantage and Part D Star Ratings: Key Observations and Takeaways
2024 Star Ratings, which CMS released on October 13, 2023, has forced the industry to reflect upon and restrategize the path forward with newer evaluation dynamics at play. The resulting turbulence has clearly underscored the fact that auto-pilot mode is … Read More
The Inovaare – MongoDB Partnership: Unlocking Excellence in Healthcare Compliance
In a world of evolving healthcare regulations, compliance isn’t just a mandate – it’s a cornerstone of success for payers and providers. To help organizations gain continual success around compliance, Inovaare, and MongoDB have partnered to bring AI technologies and … Read More
How Price Transparency in Healthcare Affects Providers, Payers and Patients
Price transparency is a term that has recently become a leading factor among healthcare payers and providers. It’s a tool used to help patients know the price of a hospital service or product before receiving it. As of January 1, … Read More