In the Contract Year 2027 Proposed Rule (CMS-4212-P), CMS introduced significant changes to how provider network changes are handled, which will directly impact health plan operations and enrollment stability. For health plan leaders, the headline is clear: the proposed changes remove historical guardrails around network stability, potentially
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CMS Finalizes Medicare Plan Finder 2027 Rule: What Health Plans Need to Know In one of the most consequential transparency updates in recent years, CMS has finalized new requirements that will make Medicare Advantage (MA) provider directories publicly available on Medicare Plan Finder beginning with plan year 2027. This change marks a
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Charles Baker, VP, Compliance Solutions Over the past three years, CMS hasn’t shouted, but it has indeed spoken. Quietly, steadily, and now unmistakably, the agency has cranked up oversight of Medicare Advantage and Part D plans. And the 2024 audit cycle? It’s not just louder— it’s broader, sharper,
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In the HEALTHCARE STARcast, host Subbu Ramalingam breaks down the complex world of healthcare to reveal the real strategies and mindsets driving excellence. In this episode, Subbu Ramalingam talks with Charles Baker, Vice President of Compliance Solutions at ATTAC Consulting Group. Charles has worn many hats in
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Charles Baker, VP, Compliance Solutions Tammy Hall, Sr. Consultant, Compliance & Health Plan Operations Introduction The 2026 Contract Year Final Rule for Medicare Advantage (MA) and Part D Prescription Drug Plans largely fell flat in comparison to previous rule making cycles in contrast to the 2026 Proposed
Read More →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
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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 →December 5, 2024 issue of RADAR on Medicare Advantage Multiple industry experts say the current administration’s last major Medicare Advantage and Part D rulemaking attempt was largely “business as usual,” with CMS expanding on policies of the Joe Biden presidency and digging further into persistent issues like
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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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Nov. 7, 2024 issue of RADAR on Medicare Advantage Based on a review of select diagnosis codes submitted by Medicare Advantage plans for risk-adjusted reimbursement dating back to 2015, the HHS Office of Inspector General (OIG) estimates that 34 MA contracts received at least $801.3 million in
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