Important Updates for CMS Calendar Year 2025 Evidence of Coverage (EOC) Models

On December 10, 2024   /   Firm News  
Important Updates for CMS Calendar Year 2025 Evidence of Coverage (EOC) Models

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,

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RADAR on Medicare Advantage | Biden Admin Seeks Broader Review of Marketing Materials, But Will Trump Admin See Overreach?

On December 6, 2024   /   Compliance, Firm News, Media Coverage, Medicare Advantage  
RADAR on Medicare Advantage | Biden Admin Seeks Broader Review of Marketing Materials, But Will Trump Admin See Overreach?

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

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CMS Announces Updates to Medicare Parts C & D Appeals Guidance Effective January 1, 2025

On November 25, 2024   /   Compliance, Medicare Advantage  
CMS Announces Updates to Medicare Parts C & D Appeals Guidance Effective January 1, 2025

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.

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Notification of Supplemental Benefits and Data Integrity: How Will CMS 2025 Final Rule Requirements Affect Your Medicare Advantage Plan?

On June 19, 2024   /   Compliance, Medicare Advantage  
Notification of Supplemental Benefits and Data Integrity: How Will CMS 2025 Final Rule Requirements Affect Your Medicare Advantage Plan?

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

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The Battle For Medicare Advantage Star Ratings: SCAN and Elevance Victories Provide a Roadmap for Plans to Challenge CMS Methodologies

On June 13, 2024   /   Compliance, Star Ratings  
The Battle For Medicare Advantage Star Ratings: SCAN and Elevance Victories Provide a Roadmap for Plans to Challenge CMS Methodologies

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

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