By Tina Gallagher, Network Strategy & Development Program Lead, ATTAC Consulting Group I just returned from the 15th Medicare Stars, HEDIS®, Quality & Risk Summit, and one theme ran through nearly every session I attended: the conversation around provider access has fundamentally changed. It wasn’t coming from one presenter or one
Read More →By Lisa Hardisty, Senior Director, Compliance Solutions, ATTAC Consulting Group At a recent SNP conference, I asked a few plan representatives a direct question: “Have you taken your Model of Care, broken it down element by element, and checked that everything you committed to is actually reflected
Read More →Section 6220 of the Consolidated Appropriations Act, 2026, also known as the REAL Health Providers Act, is already signed into law. CMS and ONC held a public stakeholder meeting on it this month and are now collecting written comments directly by email, with new Medicare Advantage provider
Read More →By Tina Gallagher, Network Strategy and Development Program Lead, ATTAC Consulting Group Chicago last week reminded me that this industry, at its best, is a community, not just a market. At the 15th Medicare Stars, HEDIS and Risk Adjustment Conference, the energy felt different. Sessions went deep,
Read More →By Regan Pennypacker, MSL, SVP, Compliance Solutions The Centers for Medicare & Medicaid Services released the CY2027 Final Rule on April 2, 2026. For compliance officers, three key areas carry operational weight: sales and marketing, eligibility for Special Supplemental Benefits for the Chronically Ill (SSBCI), and debit card supplemental benefit
Read More →CMS released the CY2027 Medicare Advantage Final Rule and Rate Announcement within four days of each other. Together, they represent a systematic restructuring of how Medicare Advantage organizations will compete, be evaluated, and be paid. This guide covers six areas of change: what shifted, what’s at stake,
Read More →Introduction For years, risk adjustment followed a predictable playbook: meet deadlines, prepare for annual RADV, and repeat. The new MA RADV audit cycles have rewritten that playbook entirely. In 2026, health plans are simultaneously managing five overlapping MA RADV audit cycles — Payment Years 2020 through 2024
Read More →Why element-level scoring is the new hurdle for SNPs As we navigate the long and winding road of 2026, a new deadline is fast approaching: the May 2026 submission window for CY 2027 guidelines. The Model of Care (MOC) has evolved into a high-stakes precision test where
Read More →The landscape of Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) has undergone a seismic shift. CMS is no longer just sampling the industry; they are auditing every eligible contract, every year. With federal estimates indicating roughly $17 billion in annual overpayments due to unsupported diagnoses, the
Read More →By Regan Pennypacker, MSL, CCEP As we turn the calendar to February, the fast-moving pace of the new year shows no sign of a slowdown. The classic tune “Under Pressure” resonates more than ever within our industry. Organizations across the country are holding their breath while waiting
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