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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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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Charles Baker, VP, Compliance Solutions Read in .pdf here The Centers for Medicare & Medicaid Services (CMS) ushered in a new era for the Medicare Advantage Part C and Prescription Drug Benefit programs with the unveiling of the Contract Year 2025 Final Rule. This comprehensive regulatory overhaul
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ATTAC’s Clinical and Compliance Experts Will Help Your Plan Prepare for a UM-Focused Audit We Also Provide Post-Audit Corrective Action and Remediation Support CMS UM-focused audits for Medicare Advantage are here. As part of the 2024 Medicare Advantage and Part D Final Rule, CMS announced that utilization management (UM)-focused
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Reprinted with AIS Health permission from the 4/4/24 issue of Radar on Medicare Advantage Thanks to a final rule published just one year ago, Medicare Advantage plans as of Jan. 1 were expected to meet new constraints when it comes to applying their utilization management (UM) policies, including
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Can you relate to this scenario? As a Medicare compliance officer, you’ve just updated your mandatory general compliance and fraud, waste and abuse training. You’re ready to send an email to all employees to launch the training. As your finger hovers over the send button, you wonder:
Read More →Dr. Michael Chapman, DO, MHCM, MS, FACOEP, is a Clinical Advisor at ATTAC Consulting Group. He is board-certified in emergency medicine, with more than a decade of clinical experience. Dr. Chapman has served as Medical Director for a health plan with more than a million members in commercial,
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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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Charles Baker, VP, Compliance Solutions The transition from Medicare-Medicaid Plans (MMPs) to Dual Eligible Special Needs Plans (D-SNPs) in California, particularly under the Medi-Cal program, is a pivotal part of a broader shift toward more integrated and coordinated care. This move is a key aspect of the
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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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