CMS recently released updated operational guidance for Contract Year (CY) 2027 Medicare Advantage (MA) applications. This guidance introduces pivotal shifts in how organizations manage network adequacy and exception requests, meaning the “old way” of managing deficiencies is no longer sufficient for those preparing for the February submission.
Read More →
We are pleased to announce the appointment of Regan Pennypacker, MSL, CCEP, to our executive leadership team as Senior Vice President, Compliance Solutions. Regan is a recognized leader in managed care and regulatory affairs with over 25 years of experience driving strategic compliance initiatives and operational excellence
Read More →In the Contract Year 2027 Proposed Rule (CMS-4212-P), CMS introduced significant changes to how provider network changes are handled, which will directly impact health plan operations and enrollment stability. For health plan leaders, the headline is clear: the proposed changes remove historical guardrails around network stability, potentially
Read More →As we close out 2025, the first year of mandatory secret shopper surveys under the CMS Final Rule is behind us. With the 2026 cycle starting on January 1, now is the time to apply the hard-won lessons from the inaugural reporting year. Reviewing the 2025 Access
Read More →
Major regulatory forces, from RADV extrapolation to new payment models, are converging. Here is why the next 18 months represent the most significant operational transformation in a decade. The Medicare Advantage sector is facing its most significant operational transformation in a decade. We are no longer looking
Read More →
CMS Finalizes Medicare Plan Finder 2027 Rule: What Health Plans Need to Know In one of the most consequential transparency updates in recent years, CMS has finalized new requirements that will make Medicare Advantage (MA) provider directories publicly available on Medicare Plan Finder beginning with plan year 2027. This change marks a
Read More →The Centers for Medicare & Medicaid Services (CMS) has officially released the Contract Year (CY) 2027 Notice of Intent to Apply (NOIA) for Medicare Advantage (MA) and Part D plans. Health plans preparing for new or expanded contracts should act quickly: several critical submission deadlines fall between
Read More →Regional Health Plan Boosts Risk Accuracy and ROI Through Targeted Retrospective Chart Review A regional payer operating across multiple states wanted to close a long-standing gap in risk score accuracy across its Medicare Advantage and ACA lines of business. Despite conducting routine retrospective chart reviews and following
Read More →
The Risk Adjustment Data Validation (RADV) rule was finalized by CMS in January 2023 to tighten oversight of Medicare Advantage (MA) plans. A central change was the removal of the fee-for-service (FFS) adjuster, which historically helped normalize error rates seen in MA and with those seen inRead More →
Kaiser Family Foundation Research released in August 2025 showed that one in four Medicare beneficiaries lived on less than $24,600 in income in 2024, and half lived on less than $43,200 [1]. Many have little or no savings, with 7.7 million enrollees spending more than 10% of
Read More →
