Practical perspectives on Medicare Advantage compliance, CMS audit readiness, and AI-assisted automation for payer operations.
Audit Readiness
The Centers for Medicare & Medicaid Services (CMS) has added another category of drugs—immunosuppressants—to their national audits in collaboration with […]
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Audit Readiness
The Centers for Medicare & Medicaid Services (CMS) officially announced capitation rates for Medicare Advantage (MA) plans for CY 2025 […]
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Healthcare Operations
Payment integrity and provider relations are two critical pillars of a well-functioning healthcare system. When effectively managed, they can lead […]
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Audit Readiness
The Centers for Medicare & Medicaid Services (CMS) has been processing Part D drug claim data via the Drug Data […]
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Healthcare Data Management
The recent cyberattack on a major healthcare IT vendor, as outlined in the letter from the U.S. Department of Health […]
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Healthcare Operations
Until the enactment of the Medicare Modernization Act (MMA) in 2006[1], the Centers for Medicare & Medicaid Services does not […]
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Healthcare Operations
The Centers for Medicare & Medicaid Services (CMS) uses the Hierarchical Condition Category (CMS-HCC) medicare risk adjustment model to determine […]
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Audit Readiness
On January 31, 2024, the Centers for Medicare & Medicaid Services (CMS) released a draft of the 2025 Advance Notice […]
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Insights & Perspectives
Health Care Service Corporation (HCSC) has entered into a definitive agreement to purchase Cigna’s Medicare Advantage, Medicare Supplemental Benefits, Medicare […]
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