Charles Baker, VP, Compliance Solutions | Victoria Nadzam, MSN, RN, Sr. Consultant On January 22, 2025, the Department of Health and Human Services was instructed to pause non-essential public communications and website updates. Though framed as a temporary, precautionary measure, this pause has real-world ripple effects on
Read More →In the first few weeks of Donald Trump’s second presidency, Medicare Advantage plans faced a tremendous amount of uncertainty as the White House threatened to pause federal financial assistance activities, issued multiple executive orders outlining the new administration’s priorities, and targeted diversity, equity and inclusion (DEI) initiatives
Read More →
On November 5, CMS updated URLs in the following CY 2025 EOC models: CY2025_1_HMO_MAPD_ISNP_CSNP_EOC_Correcting URLs_11042024 CY2025_2_PPO_MAPD_ISNP_CSNP_EOC_Correcting URLs_11042024 CY2025_3_DE_SNP_EOC_Correcting URLs_11042024 CY2025_4_Cost_Plan_EOC_Correcting URLs_11042024 CY2025_5_PFFS_EOC_Correcting URLs_11042024 CY2025_6_MSA_EOC_Correcting URLs_11042024 CY2025_7_HMO_MA_EOC_Correcting URLs_11042024 CY2025_8_PPO_MA_EOC_Correcting URLs_11042024 CY2025_9_PDP_EOC_Correcting URLs_11042024 The URLs required replacement due to an error in links of the previous models. For example,
Read More →
Dec 05, 2024 issue of RADAR on Medicare Advantage While the Joe Biden administration has applied many regulatory tweaks to the Medicare Advantage program in the name of improving the consumer experience, industry observers expect the incoming Donald Trump administration will take a more plan-friendly approach from
Read More →
Charles Baker, VP, Compliance Solutions | Victoria Nadzam, MSN, RN CMS has announced significant revisions to Medicare Advantage Part C and Prescription Drug plans. These changes, related to enrollee grievances, organization/coverage determinations, and appeals guidance, will take effect on January 1, 2025 and will affect plans nationwide.
Read More →
CMS has implemented significant regulatory changes to network adequacy standards that require Medicare Advantage (MA) plans to quickly adapt to ensure compliance. Read on for an overview of the necessary steps plans must take to meet these new requirements. Convert Letters of Intent. Health plans that submitted
Read More →
by Jon Rogers, Sr. Consultant, Risk Adjustment As we reach the midpoint of 2024, managed care organizations (MCOs) must take a close look at their In-Home Health Assessment (IHHA) programs, which play a critical role in managing the health of Medicare Advantage and Affordable Care Act populations.
Read More →
Charles Baker, VP, Compliance Solutions and Tammy Hall, Senior Consultant, Compliance Solutions Medicare Advantage (MA) plans offering supplemental benefits have reported enrollee underutilization of many of these benefits. Supplemental benefits may include hearing, dental, vision, fitness programs, over-the-counter drugs, transportation for medical appointments, and other services that address
Read More →
By Charles Baker, VP, Compliance Solutions In the world of Medicare Advantage, the calculation of Star Ratings is more than a measure of quality – it’s a pivotal marker that can significantly sway federal funding and market competitiveness. Against the backdrop of high financial stakes and rigorous
Read More →
by Lynn Kryfke, MSN, RN, Sr. Consultant, Risk Adjustment | Jon Rogers, Sr. Consultant, Risk Adjustment Telehealth has been around for decades, but the COVID-19 pandemic thrust it into the spotlight when patients couldn’t see practitioners in-person. Suddenly, telehealth via video, audio, text, and email became a
Read More →
