RADAR on Medicare Advantage, June 5, 2025 Following up on promises to root out fraud, waste and abuse in government-sponsored programs, CMS on May 21 stunned the industry with a bold plan to rapidly expand risk adjustment data validation audits (RADV) used to collect overpayments from Medicare
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Health Plan Weekly, May 30, 2025 Amid a flurry of CMS announcements about health care price transparency and Medicaid issues, the agency on May 21 unveiled a bold plan to collect Medicare Advantage overpayments through the expansion of Risk Adjustment Data Validation (RADV) audits. Industry analysts say the news
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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
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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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Nov. 7, 2024 issue of RADAR on Medicare Advantage Based on a review of select diagnosis codes submitted by Medicare Advantage plans for risk-adjusted reimbursement dating back to 2015, the HHS Office of Inspector General (OIG) estimates that 34 MA contracts received at least $801.3 million in
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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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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
Read More →RADAR on Medicare Advantage | Risk Scores, Star Ratings Are Catalysts to Watch in Medicare Advantage
Reprinted with AIS Health permission from the 1/4/24 issue of Radar on Medicare Advantage 2024 Medicare Advantage Outlook For our annual series of outlook stories on the year ahead in Medicare Advantage, AIS Health, a division of MMIT, spoke with more than a dozen industry experts on the
Read More →Reprinted with AIS Health permission from the Oct. 5 issue of Radar on Medicare Advantage As the 2024 Annual Election Period approaches, Medicare Advantage insurers that began marketing on Oct. 1 have been touting service area expansions and/or the robust provider networks attached to their plans. But
Read More →Medicare Advantage organizations may not have gotten the outcome they were hoping for in CMS’s recently finalized Risk Adjustment Data Validation rule, but industry experts say they weren’t surprised by the position CMS ultimately took after years of pressure to close out RADV audits and recover identified
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