RISK ADJUSTMENT

ATTAC’s Top Added & Top Failed RADV HCCs by Volume

Risk Adjustment Compliance: Top 4 Vendor Oversight Considerations

Three Steps to Build a Strong 2023 Risk Adjustment Plan

Risk Adjustment Compliance & ICD-10 Diagnosis Code Accuracy: Three Areas of Concern Identified by OIG 

Overpayment Rule Stands: Review Your Plan’s Processes & Procedures Now to Avoid False Claims Act Liability

Risk Adjustment: Three Steps to Review & Set Strategy for Upcoming Retrospective Interventions

It’s Time to Review Your Risk Adjustment Vendor Contracts

COMPLIANCE

Warning: CMS on Hunt for Deceptive Medicare Advantage Advertising

Telehealth Fraud, Waste & Abuse: How to Develop a Prevention & Detection Program

HPMS Memo: Transfer of Submitted Multi-Plan Marketing Materials

CMS Releases First-Ever Home- and Community-Based Services Quality Measure Set 

CMS Updates: Parts C & D Enrollee Grievances, Organization Coverage Determinations & Appeals Guidance 

Increased Medicare Beneficiary Complaints About Third-party Marketing Leads to New Requirements For Agent/Broker Training

CY 2023 Medicare Advantage & Part D Marketing & Communications Final Rule & Impact to Medicare Advantage Dual Eligible Special Needs Plans

Top Ten Steps for Exclusion Monitoring Compliance

PROVIDER NETWORK MANAGEMENT 

Four Steps For a Successful Provider Engagement Strategy

Medicare Advantage Plans Completing Applications for New Markets or Service Areas Must Build-out Provider Networks at Same Time

Provider Access & Availability Surveys: Is Your Plan Meeting Access to Care and Appointment Availability Requirements?

BUSINESS TRANSFORMATION

Five Keys to Successful Project Management

CMS Announces Race & Ethnicity Data Changes For Medicare Advantage & Part D plans

Is Your Plan Ready for Medicaid Redetermination? 

New Medicare Advantage Prior Authorization Requirements Unanimously Passed by House 

MEDIA COVERAGE

Radar on Medicare Advantage | New Prior Authorization Rule Aims to Quicken Senior Access to Care

Fierce Healthcare | Medicare Advantage at Tipping Point: A Preview of 2023 Open Enrollment

RADAR on Medicare Advantage | New Third-Party Marketing Oversight Duties Have Industry Scrambling Before AEP

Health Plan Weekly |Behavioral Health Network Issues Lead to $4.6M Fine for Molina RADAR on Medicare Advantage

Health Plan Weekly | North Carolina Sets Sights on Medicaid Expansion

Radar on Medicare Advantage | CMS Bulletin Could Mean Greater Oversight of Medicaid Network Adequacy

NEWSLETTERS

December, 2022

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