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
Read More →It’s time for plans to transition from a waiting period to a move-forward moment After five years of waiting, Medicare Advantage plans now know CMS’s position on CMS and OIG audit extrapolations. It’s time for plans to transition from a waiting period to a move-forward moment, and to
Read More →Many insurers in the commercial space have not yet undergone a market conduct exam, while others have not been tested on elements such as mental health parity Most plans have a well-defined process for responding to common state and federal audits. However, many plans are not as familiar
Read More →The CDC released ICD-10 code changes that go into effect April 1, 2023. All of the code changes are related to improving the capture of Social Determinants of Health (SDOH) information. There are 42 code changes aimed at improved specificity when documenting SDOH conditions, including classifications of:
Read More →CMS released the Medicare Program; Contract Year 2024 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, Medicare Parts A, B, C, and D Overpayment Provisions of the Affordable Care Act and Programs of All-Inclusive Care for the
Read More →CMS released the Medicare Program; Contract Year 2024 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, Medicare Parts A, B, C, and D Overpayment Provisions of the Affordable Care Act and Programs of All-Inclusive Care for the
Read More →EDGE, which stands for External Data Gathering Environment, is a common acronym within the risk adjustment space. Often referred to as the EDGE Server or simply EDGE, it’s the endpoint for ACA Marketplace data submissions. While the need for complete, accurate and timely submission of data is
Read More →CMS released the Medicare Program; Contract Year 2024 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, Medicare Parts A, B, C, and D Overpayment Provisions of the Affordable Care Act and Programs of All-Inclusive Care for the
Read More →Every Medicare Advantage organization and prescription drug plan is required to contract with an independent auditor to conduct a CMS Data Validation Audit (DVA) each contract year. Whether you’re an existing plan or new to the DVA process, it’s imperative to select the right auditor. We know
Read More →2024 Proposed Rule Changes: Impacts to Medicare Advantage & ACA Provider Directories and Contracting
CMS released the Medicare Program; Contract Year 2024 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, Medicare Parts A, B, C, and D Overpayment Provisions of the Affordable Care Act and Programs of All-Inclusive Care for the
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