Medicare Star Ratings 2021 Changes and Strategies to Address
It has become evident by changes to the Centers for Medicare & Medicaid Services (CMS) Star Rating formulas over the […]
Automation in Healthcare
Medicare Appeals Best Practices​
How can health plans improve their Medicare appeals processes? For many health plans serving the Medicare population, they will have
Forewarned is Forearmed: Prepare for 2021 CMS Audit Protocols Change
While the world is anything but predictable—especially in the age of COVID-19—the Centers for Medicare and Medicaid (CMS) isn’t being
Are you in control of your compliance processes?
Compliance maintenance and oversight for health plans can be a resource and time-consuming restraint. Challenges with manual processes, inefficient workflows
CMS Program Audit Universes as a Tool for Ongoing Compliance Monitoring
One of the most arduous and time-consuming activity for MAPD and PDP plans is the creation of the required universes
How To Optimize your Appeals and Grievances Process?
When it comes to appeals and grievances process, most healthcare organizations struggle to improve compliance, productivity, visibility, and ratings while
Reasonable Outreach: Are you missing what CMS expects?
The Centers for Medicare & Medicaid Services (CMS) on April 20th of 2016 released several job aids in order to
2015/2016 CMS Program Audit Protocols and Process Updates
CMS program audit evaluate the performance of the Medicare Advantage/Prescription drug plans (MAPDs) and prescription drug plans (PDPs) that provide