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
Read More →
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
Read More →
Charles Baker, VP, Compliance Solutions | Victoria Nadzam, MSN, RN CMS has announced significant revisions to Medicare Advantage Part C and Prescription Drug plans. These changes, related to enrollee grievances, organization/coverage determinations, and appeals guidance, will take effect on January 1, 2025 and will affect plans nationwide.
Read More →
Charles Baker, VP, Compliance Solutions On July 3, 2024, the U.S. District Court for the Northern District of Texas issued a preliminary injunction, halting the implementation of certain provisions within the CMS Final Rule for Contract Year 2025. This rule aimed to overhaul the compensation arrangements between
Read More →
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
Read More →
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
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,
Read More →
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,
Read More →
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 →
