Navigating Star Ratings in the Aftermath of CMS Plan Preview 2: Actionable Steps for Medicare Advantage Plans in 2023 and Beyond

Navigating Star Ratings in the Aftermath of CMS Plan Preview 2: Actionable Steps for Medicare Advantage Plans in 2023 and Beyond

Charles Baker, VP, Compliance Solutions The recent CMS Plan Preview 2 brought a collective gasp across the Medicare Advantage world. With many healthcare plans still celebrating high Star Ratings from 2022 and 2023, CMS applying the Tukey Method of analysis that resulted in adjusted cut points felt

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Compliance Isn’t Just Compliance Anymore: Three Ways Medicare Advantage Teams Can Shift From Retrospective Oversight & Deliver Strategic Value 

Compliance Isn’t Just Compliance Anymore: Three Ways Medicare Advantage Teams Can Shift From Retrospective Oversight & Deliver Strategic Value 

Charles Baker, VP, Compliance Solutions Compliance belongs at the strategic decision-making table to ensure the seamless integration of regulatory guidelines into the fabric of effective programs. For years, compliance in the health insurance sector, especially regarding government programs, has been synonymous with regulatory oversight. Compliance departments have

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Medicare-Medicaid Plans to Undergo Performance Measure Validation for 2023 Cycle 

Medicare-Medicaid plans (MMPs) report monitoring and performance measures consistent with the three-way contracts with states, the Medicare-Medicaid capitated financial alignment model core reporting requirements, and state-specific reporting requirements.   For the 2023 performance measure validation (PMV) cycle (covering data reported for the 2022 measurement year), CMS will select

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New Proposed Medicaid Regulations Aim to Enhance Access to Care & Health Equity | Submit Comments by July 3, 2023

New Proposed Medicaid Regulations Aim to Enhance Access to Care & Health Equity | Submit Comments by July 3, 2023

The proposed rule, Ensuring Access to Medicaid Services, includes changes to existing requirements and introduces new requirements. The proposed regulations advance CMS’s efforts to improve access to care, quality and health outcomes; the regulations are intended to promote health equity across fee-for-service (FFS) and managed care delivery

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Navigating the 2023 CMS Program Audit: Are You Ready?

CMS has initiated routine program audits by sending engagement letters to Medicare Advantage organizations, prescription drug plans and Medicare-Medicaid plans. Are You Audit-Ready? If your plan receives an engagement letter, are you prepared to respond within 15 business days, or do you feel nervous and hope you

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