[Webinar Replay] CMS 2025 Final Rule & Mental Health Parity: Regulatory Changes Providers & Plans Need to Know

Catch the webinar replay for expert insights on impacts of the CMS Final Rule. We discuss: Mental Health Parity | Significant changes will impact provider network operations and reimbursement. Provider Network Requirements | Tightened network adequacy standards are intended to ensure that plans provide beneficiaries with timely

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Medicaid and CHIP Provider Access Survey Requirements: Are You Ready to Meet CMS and State Access to Care Requirements in Plan Year 2025?

Medicaid and CHIP Provider Access Survey Requirements: Are You Ready to Meet CMS and State Access to Care Requirements in Plan Year 2025?

By Jocelyn Bayliss The 2025 Final Rule from CMS outlined expectations and reporting requirements related to timely access to care. Effective PY 2025, CMS requires that all states with Medicaid and the Children’s Health Insurance Program (CHIP) develop, conduct, and enforce independent secret shopper surveys to evaluate

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Enhancing Provider Engagement: 9 Best Practices for Optimizing In-Office Assessments for Risk Adjustment

Enhancing Provider Engagement: 9 Best Practices for Optimizing In-Office Assessments for Risk Adjustment

by Jon Rogers, Sr. Consultant, Risk Adjustment As the fourth quarter approaches, managed care organizations (MCOs) should focus on optimizing their risk adjustment in-office assessment (IOA) processes to ensure accurate patient assessments, which are crucial for both appropriate revenue realization and quality care management. The following comprehensive

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The Roller Coaster Continues: Preliminary Injunction Preserves Field Marketing Organization Compensation Practices For Medicare Advantage and Part D Plans

The Roller Coaster Continues: Preliminary Injunction Preserves Field Marketing Organization Compensation Practices For Medicare Advantage and Part D Plans

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

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