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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CMS is launching the most extensive RADV audit expansion in Medicare Advantage history. Health plans need to move quickly—and smartly—to reduce risk and limit exposure. One of the most common (and costly) mistakes? Contracting with the same vendors used for retrospective coding. Coders trained for retro reviews may bring
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Subbu Ramalingam, Managing Director, ATTAC Consulting Group As we enter the second half of 2025, health plans and provider organizations are approaching a critical strategic inflection point. With the final push to close out 2026 health plan products, HEDIS® seasons and CAHPS® surveys—and the ongoing need for
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Charles Baker, VP, Compliance Solutions Tammy Hall, Sr. Consultant, Compliance & Health Plan Operations Introduction The 2026 Contract Year Final Rule for Medicare Advantage (MA) and Part D Prescription Drug Plans largely fell flat in comparison to previous rule making cycles in contrast to the 2026 Proposed
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Charles Baker, VP, Compliance Solutions | Victoria Nadzam, MSN, RN, Sr. Consultant On January 22, 2025, the Department of Health and Human Services was instructed to pause non-essential public communications and website updates. Though framed as a temporary, precautionary measure, this pause has real-world ripple effects on
Read More →Listen along for a wide-ranging conversation on the Health Elevated podcast. The discussion covers aspects of the healthcare system, including operations, process improvement, financial management, and the role of data science in healthcare innovation. The conversation explores who holds responsibility within the healthcare system—providers, payers, or patients
Read More →Charles Baker, VP, Compliance Solutions President Trump’s executive order to freeze federal regulations has left the healthcare industry, particularly the Medicare Advantage (MA) program, in a state of uncertainty. The freeze, which is intended to align current and proposed rules with the administration’s priority of “reducing the
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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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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
Read More →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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