Why element-level scoring is the new hurdle for SNPs As we navigate the long and winding road of 2026, a new deadline is fast approaching: the May 2026 submission window for CY 2027 guidelines. The Model of Care (MOC) has evolved into a high-stakes precision test where
Read More →By Regan Pennypacker, MSL, CCEP As we turn the calendar to February, the fast-moving pace of the new year shows no sign of a slowdown. The classic tune “Under Pressure” resonates more than ever within our industry. Organizations across the country are holding their breath while waiting
Read More →CMS recently released updated operational guidance for Contract Year (CY) 2027 Medicare Advantage (MA) applications. This guidance introduces pivotal shifts in how organizations manage network adequacy and exception requests, meaning the “old way” of managing deficiencies is no longer sufficient for those preparing for the February submission.
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Major regulatory forces, from RADV extrapolation to new payment models, are converging. Here is why the next 18 months represent the most significant operational transformation in a decade. The Medicare Advantage sector is facing its most significant operational transformation in a decade. We are no longer looking
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The Risk Adjustment Data Validation (RADV) rule was finalized by CMS in January 2023 to tighten oversight of Medicare Advantage (MA) plans. A central change was the removal of the fee-for-service (FFS) adjuster, which historically helped normalize error rates seen in MA and with those seen inRead More →
Kaiser Family Foundation Research released in August 2025 showed that one in four Medicare beneficiaries lived on less than $24,600 in income in 2024, and half lived on less than $43,200 [1]. Many have little or no savings, with 7.7 million enrollees spending more than 10% of
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Charles Baker, VP, Compliance Solutions Congress may be stuck in partisan stalemates, but risk adjustment reform is one area where the gears are still turning. The No UPCODE Act (S.1105), introduced this spring, has quickly become the focal point for Medicare Advantage payment debates. What’s in the Bill? Chart reviews
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Charles Baker, VP, Compliance Solutions Over the past three years, CMS hasn’t shouted, but it has indeed spoken. Quietly, steadily, and now unmistakably, the agency has cranked up oversight of Medicare Advantage and Part D plans. And the 2024 audit cycle? It’s not just louder— it’s broader, sharper,
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In the HEALTHCARE STARcast, host Subbu Ramalingam breaks down the complex world of healthcare to reveal the real strategies and mindsets driving excellence. In this episode, Subbu Ramalingam talks with Charles Baker, Vice President of Compliance Solutions at ATTAC Consulting Group. Charles has worn many hats in
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Charles Baker, VP, Compliance Solutions Tammy Hall, Sr. Consultant, Compliance & Health Plan Operations CMS began a deeper dive into utilization management (UM) for Part C services with the implementation of new UM requirements released in the 2024 Final Rule. On May 30, 2025, CMS raised the red
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