Charles Baker, VP, Compliance Solutions Read in .pdf here The Centers for Medicare & Medicaid Services (CMS) ushered in a new era for the Medicare Advantage Part C and Prescription Drug Benefit programs with the unveiling of the Contract Year 2025 Final Rule. This comprehensive regulatory overhaul
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ATTAC’s Clinical and Compliance Experts Will Help Your Plan Prepare for a UM-Focused Audit We Also Provide Post-Audit Corrective Action and Remediation Support CMS UM-focused audits for Medicare Advantage are here. As part of the 2024 Medicare Advantage and Part D Final Rule, CMS announced that utilization management (UM)-focused
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Reprinted with AIS Health permission from the 4/4/24 issue of Radar on Medicare Advantage Thanks to a final rule published just one year ago, Medicare Advantage plans as of Jan. 1 were expected to meet new constraints when it comes to applying their utilization management (UM) policies, including
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by Lynn Kryfke, MSN, RN, Sr. Consultant, Risk Adjustment | Jon Rogers, Sr. Consultant, Risk Adjustment CMS recently announced its Innovation in Behavioral Health Model, intended to “improve quality of care, access, and outcomes for people with mental health conditions and substance use disorders in Medicaid and Medicare.”
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Charles Baker, VP, Compliance Solutions The recent cyberattack on Change Healthcare affected clinical-decision support, eligibility verifications, chart abstractions, and pharmacy operations, and has highlighted vulnerabilities within the industry’s digital infrastructure. In light of these disruptions, plans need to explore the broader implications, particularly concerning Part D, CAHPS,
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Charles Baker, VP, Compliance Solutions The transition from Medicare-Medicaid Plans (MMPs) to Dual Eligible Special Needs Plans (D-SNPs) in California, particularly under the Medi-Cal program, is a pivotal part of a broader shift toward more integrated and coordinated care. This move is a key aspect of the
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by Lynn Kryfke, MSN, RN, Sr. Consultant, Risk Adjustment | Jon Rogers, Sr. Consultant, Risk Adjustment As CMS continues to evolve its Medicare Advantage risk adjustment methodology, significant changes have been made to the behavioral health Hierarchical Condition Categories (HCCs). Starting with the 2024 payment year, the
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– by Lynn Kryfke, MSN, RN, Sr. Consultant, Risk Adjustment | Jon Rogers, Sr. Consultant, Risk Adjustment Leading healthcare organizations are developing strategies to align their programs and streamline the process of gathering crucial data to better serve beneficiaries. With the goal of achieving population health, managed
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Reprinted with AIS Health permission from the 1/4/24 issue of Radar on Medicare Advantage 2024 Medicare Advantage Outlook For our annual series of outlook stories on the year ahead in Medicare Advantage, AIS Health, a division of MMIT, spoke with more than a dozen industry experts on the
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Charles Baker, VP, Compliance Solutions The Centers for Medicare & Medicaid Services (CMS) continues to build upon its strategy to support person-centered, value-based care through the 2025 Medicare Advantage and Part D programs proposed rule. These proposals, a bold stride towards enhancing health equity, transparency, and patient-centric
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