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 […]
Healthcare Compliance and Regulatory Insights
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
How Price Transparency in Healthcare Affects Providers, Payers and PatientsÂ
Price transparency is a term that has recently become a leading factor among healthcare payers and providers. It’s a tool
What you should know about Part B drug payments to comply with IRA 2022
The Inflation Reduction Act of 2022 has wide-ranging impact on payments for drugs used by Medicare beneficiaries, whether they are
ACA Health Plans — Key considerations for staying relevant
A perspective on recent industry shifts influencing ACA plan operations in states, which are yet to adopt ACA Medicaid expansion
Is your Medicare Advantage Organization Ready for Compliance with Regulatory Changes in 2023?
Annual Election Period (AEP) is about two weeks away when Medicare Advantage Prescription Drug Plans (MAPD) will be signing up
CY 2022 CMS Program Audit Protocols Changes
The Centers for Medicare & Medicaid Services (CMS) launched a new cycle of program audits in February 2022. Multiple Medicare
Theme and Focus for Medicare Regulations for Calendar Year (CY) 2023
On February 2, 2022, the Centers for Medicare & Medicaid Services (CMS) released the CY 2023 Advance Notice of Methodological
CMS 2022 Protocols for MMP SARAG & MMP CDAG Universe Submission
It is that time again! CMS Program Audits are imminent and the protocols have officially changed for 2022. This blog
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