RADAR on Medicare Advantage | CMS’s $40B GLP-1 Proposal Offers Leeway for Part D Plans to Define Obesity

RADAR on Medicare Advantage | CMS’s $40B GLP-1 Proposal Offers Leeway for Part D Plans to Define Obesity

December 5, 2024 issue of RADAR on Medicare Advantage Acknowledging the growing prevalence of obesity in the U.S. and its existence as a chronic disease, CMS in its proposed Medicare Advantage and Part D rule for the 2026 contract year included a landmark provision to expand Medicare

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RADAR on Medicare Advantage | Biden Admin Seeks Broader Review of Marketing Materials, But Will Trump Admin See Overreach?

RADAR on Medicare Advantage | Biden Admin Seeks Broader Review of Marketing Materials, But Will Trump Admin See Overreach?

Dec 05, 2024 issue of RADAR on Medicare Advantage While the Joe Biden administration has applied many regulatory tweaks to the Medicare Advantage program in the name of improving the consumer experience, industry observers expect the incoming Donald Trump administration will take a more plan-friendly approach from

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RADAR on Medicare Advantage | CMS Rule Seeks to More Clearly Define Internal Coverage Criteria, AI-Driven Tools

RADAR on Medicare Advantage | CMS Rule Seeks to More Clearly Define Internal Coverage Criteria, AI-Driven Tools

December 5, 2024 issue of RADAR on Medicare Advantage Multiple industry experts say the current administration’s last major Medicare Advantage and Part D rulemaking attempt was largely “business as usual,” with CMS expanding on policies of the Joe Biden presidency and digging further into persistent issues like

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CMS Announces Updates to Medicare Parts C & D Appeals Guidance Effective January 1, 2025

CMS Announces Updates to Medicare Parts C & D Appeals Guidance Effective January 1, 2025

Charles Baker, VP, Compliance Solutions | Victoria Nadzam, MSN, RN CMS has announced significant revisions to Medicare Advantage Part C and Prescription Drug plans. These changes, related to enrollee grievances, organization/coverage determinations, and appeals guidance, will take effect on January 1, 2025 and will affect plans nationwide.

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Victoria Nadzam, MSN, RN, Joins ATTAC Consulting Group as Sr. Consultant For Compliance Solutions

Victoria Nadzam, MSN, RN, is an accomplished healthcare professional with expertise in clinical operations management, process and performance improvement, and accreditation and regulatory compliance. She has a proven track record of driving compliance with NCQA standards and optimizing healthcare delivery across diverse sectors, including Medicare, commercial ACA,

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The Roller Coaster Continues: Preliminary Injunction Preserves Field Marketing Organization Compensation Practices For Medicare Advantage and Part D Plans

The Roller Coaster Continues: Preliminary Injunction Preserves Field Marketing Organization Compensation Practices For Medicare Advantage and Part D Plans

Charles Baker, VP, Compliance Solutions On July 3, 2024, the U.S. District Court for the Northern District of Texas issued a preliminary injunction, halting the implementation of certain provisions within the CMS Final Rule for Contract Year 2025. This rule aimed to overhaul the compensation arrangements between

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Notification of Supplemental Benefits and Data Integrity: How Will CMS 2025 Final Rule Requirements Affect Your Medicare Advantage Plan?

Notification of Supplemental Benefits and Data Integrity: How Will CMS 2025 Final Rule Requirements Affect Your Medicare Advantage Plan?

Charles Baker, VP, Compliance Solutions and Tammy Hall, Senior Consultant, Compliance Solutions Medicare Advantage (MA) plans offering supplemental benefits have reported enrollee underutilization of many of these benefits. Supplemental benefits may include hearing, dental, vision, fitness programs, over-the-counter drugs, transportation for medical appointments, and other services that address

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The Battle For Medicare Advantage Star Ratings: SCAN and Elevance Victories Provide a Roadmap for Plans to Challenge CMS Methodologies

The Battle For Medicare Advantage Star Ratings: SCAN and Elevance Victories Provide a Roadmap for Plans to Challenge CMS Methodologies

By Charles Baker, VP, Compliance Solutions In the world of Medicare Advantage, the calculation of Star Ratings is more than a measure of quality – it’s a pivotal marker that can significantly sway federal funding and market competitiveness. Against the backdrop of high financial stakes and rigorous

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