In the HEALTHCARE STARcast, host Subbu Ramalingam breaks down the complex world of healthcare to reveal the real strategies and mindsets driving excellence. In this episode, Subbu Ramalingam talks with Charles Baker, Vice President of Compliance Solutions at ATTAC Consulting Group. Charles has worn many hats in
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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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In the 2025 Final Rule, CMS released its expectations and reporting requirements to ensure timely access to care. By the second Friday in June each year, issuers that offer Qualified Health Plans (QHPs)—including stand-alone dental plans—in the federally-facilitated exchanges or the federally-facilitated Small Business Health Options Programs
Read More →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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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
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The new administration brings opportunities and challenges for the healthcare industry. While final regulatory guidance has not yet been released, health plans and providers will need to respond quickly when changes are finalized. An agile strategy, with the ability to rapidly deploy an expert workforce, is critical.
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