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
Read More →Foreword from report issued July 18, 2023 by CMS’ Medicare Parts C and D Oversight and Enforcement Group: Read full report here The Medicare Parts C and D Oversight and Enforcement Group (MOEG) in the Centers for Medicare & Medicaid Services (CMS) has historically released an annual
Read More →Medicare-Medicaid plans (MMPs) report monitoring and performance measures consistent with the three-way contracts with states, the Medicare-Medicaid capitated financial alignment model core reporting requirements, and state-specific reporting requirements. For the 2023 performance measure validation (PMV) cycle (covering data reported for the 2022 measurement year), CMS will select
Read More →It’s crucial for health plans and plan sponsors to verify the accuracy and timeliness of benefit documents, such as Certificates of Coverage, Summary Plan Descriptions, and Evidence of Coverages, as they finalize annual changes to benefit plan designs. Some plans have discovered during audits by a Department
Read More →CMS has initiated routine program audits by sending engagement letters to Medicare Advantage organizations, prescription drug plans and Medicare-Medicaid plans. Are You Audit-Ready? If your plan receives an engagement letter, are you prepared to respond within 15 business days, or do you feel nervous and hope you
Read More →Plans should begin using the updated IDN no later than May 2, 2023 CMS updated an Office of Management and Budget-approved standardized Notice of Denial of Medical Coverage (or Payment), also known as the Integrated Denial Notice (IDN). Medicare health plans, including Dual-Eligible Special Needs plans (DSNPs),
Read More →Highlights from HCCA 2023 Managed Care Compliance Conference Presentation by Anne Crawford, ATTAC Consulting Group | Sandra J. Durkin, Strategic Health Law Click here to see full presentation
Read More →With telehealth utilization at 38x what it was pre-pandemic, plan sponsors should address telehealth fraud as part of overall anti-fraud, waste and abuse plans The pandemic had a tremendous impact on healthcare delivery. Fee-for-service Medicare previously offered telehealth services on a limited basis—mostly to beneficiaries in rural
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