The Aftermath of the Change Healthcare Cyberattack: A Call to Action for Health Plans

The Aftermath of the Change Healthcare Cyberattack: A Call to Action for Health Plans

Charles Baker, VP, Compliance Solutions The recent cyberattack on Change Healthcare affected clinical-decision support, eligibility verifications, chart abstractions, and pharmacy operations, and has highlighted vulnerabilities within the industry’s digital infrastructure. In light of these disruptions, plans need to explore the broader implications, particularly concerning Part D, CAHPS,

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RADAR on Medicare Advantage | Medicare Advantage Experts Point to Member Experience, Provider Contracting as Worthy Investments

RADAR on Medicare Advantage | Medicare Advantage Experts Point to Member Experience, Provider Contracting as Worthy Investments

Reprinted with AIS Health permission from the 2/1/24 issue of Radar on Medicare Advantage 2024 Medicare Advantage Trends For our annual series of outlook stories on the year ahead in Medicare Advantage, AIS Health, a division of MMIT, asked multiple experts what they view as MA organizations’ “keys

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2025 Medicare Advantage Reforms: A Comprehensive Shift Towards Equity, Transparency and Patient-centered Care

2025 Medicare Advantage Reforms: A Comprehensive Shift Towards Equity, Transparency and Patient-centered Care

Charles Baker, VP, Compliance Solutions The Centers for Medicare & Medicaid Services (CMS) continues to build upon its strategy to support person-centered, value-based care through the 2025 Medicare Advantage and Part D programs proposed rule. These proposals, a bold stride towards enhancing health equity, transparency, and patient-centric

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[Webinar Replay] How Providers and Health Plans Can Collaborate to Maximize Revenue and Quality

[Webinar Replay] How Providers and Health Plans Can Collaborate to Maximize Revenue and Quality

In this webinar, we discuss the critical role providers play in the success of improved health outcomes, Star ratings, HEDIS measures and risk adjustment. We dive into: – What provider organizations should know about the latest trends in Star ratings, HEDIS measures and risk adjustment – Risk

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Guarding Medicare’s Future: 2025 Proposed Rule to Revolutionize Medicare Advantage Agent and Broker Compensation

Guarding Medicare’s Future: 2025 Proposed Rule to Revolutionize Medicare Advantage Agent and Broker Compensation

Charles Baker, VP, Compliance Solutions The issue of Medicare Advantage (MA) plans paying administrative fees to field marketing organizations (FMOs) and agents is a hot topic. This is particularly true in light of recent congressional oversight hearings and the newly released 2025 Medicare Advantage Part D proposed

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Compliance Isn’t Just Compliance Anymore: Three Ways Medicare Advantage Teams Can Shift From Retrospective Oversight & Deliver Strategic Value 

Compliance Isn’t Just Compliance Anymore: Three Ways Medicare Advantage Teams Can Shift From Retrospective Oversight & Deliver Strategic Value 

Charles Baker, VP, Compliance Solutions Compliance belongs at the strategic decision-making table to ensure the seamless integration of regulatory guidelines into the fabric of effective programs. For years, compliance in the health insurance sector, especially regarding government programs, has been synonymous with regulatory oversight. Compliance departments have

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Medicare Advantage Initial or Service Area Expansion Application: Finalize CY 2024 and Prepare for CY 2025 

Per the CY 2023 Final Rule published on May 9, 2022, CMS requires applicants to demonstrate a sufficient network of contracted providers to care for beneficiaries before approving their application. Additionally, for CY 2024, CMS adopted regulations explicitly stating that applications may be denied if network adequacy

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