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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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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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
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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.
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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
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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
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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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