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 […]
Health Cloud Platform
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
The Inovaare – MongoDB Partnership: Unlocking Excellence in Healthcare Compliance
Add New Post In a world of evolving healthcare regulations, compliance isn’t just a mandate – it’s a cornerstone of
Enhancing Delegation Oversight: The Role of Technology Solutions in Health Plans
In the ever-evolving landscape of healthcare, health plans are realizing the importance of leveraging technology solutions to improve their delegation
Optimizing Appeal Decisions
Medical Directors need relevant Information. Health plans must identify the key pieces of information Medical Directors will need in order
Monitor Improper Payments for Part C and Part D with Medicare Audit and Monitoring Software
The monthly premium for Medicare Part B rose 14.5%, from $148.50 in 2021 to $170.00 in 2022, which is partly
Enhance Member Satisfaction by Accurately Classifying Grievances with AI-powered Grievance Management Software
Healthcare organizations establish Compliance Departments with the primary purpose of providing compliance oversight for the organization. Operational teams—such as the
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
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
Americans with Disabilities Act (ADA) Changes
I attended a call recently with CMS and the ADA, CMS is looking to adhere to the Americans with Disabilities