Capitation Rates Announcement for Medicare Advantage Plans for CY 2025
The Centers for Medicare & Medicaid Services (CMS) officially announced capitation rates for Medicare Advantage (MA) plans for CY 2025 […]
Medicare
Changes for Prescription Drug Encounter (PDE) Data in 2024
The Centers for Medicare & Medicaid Services (CMS) has been processing Part D drug claim data via the Drug Data
Strategies for Proper Payments for Part B and Part D Drugs
Until the enactment of the Medicare Modernization Act (MMA) in 2006[1], the Centers for Medicare & Medicaid Services does not
Medicare Part D Risk Adjustments and Bidding Instructions for 2025
The Centers for Medicare & Medicaid Services (CMS) uses the Hierarchical Condition Category (CMS-HCC) medicare risk adjustment model to determine
Understanding the 2025 Medicare Part D Re-design: What You Need to Know
The Prescription Drug Program, commonly known as Medicare Part D, is undergoing significant transformations in 2025 due to the Inflation
2024 CMS Program Audit Updates: Summary and Insights
Summary of the HPMS Memo Generated by USHER (Inovaare’s AI-powered Compliance Assistant) The Centers for Medicare and Medicaid Services (CMS)
Preparing for 2024: Essential Compliance Checklist for Medicare Advantage Organizations
The Annual Election Period (AEP) has ended. Before the Medicare Advantage Open Enrollment Period (MA OEP)[1] begins on January 1, 2024,
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
What you should know about Part B drug payments to comply with IRA 2022
The Inflation Reduction Act of (IRA) 2022 has wide-ranging impact on payments for drugs used by Medicare beneficiaries, whether they
Discover what’s new for Program Audit ODAG Protocol in 2022
The Centers for Medicare & Medicaid Services (CMS) launched a new cycle of CMS program audits in February 2022. Even