top of page
Latest News
Search
2 days ago3 min read
Key Factors Driving C-SNP Growth and Why Health Plans Should Invest
The Medicare Advantage market is ever-evolving, with Chronic Condition Special Needs Plans (C-SNPs) emerging as a notable growth area....
30 views0 comments
Feb 72 min read
Top Compliance Takeaways from HCCA – Is Your Plan Ready?
Coming out of the HCCA Compliance Conference this week, one thing is clear—compliance and regulatory oversight are evolving rapidly....
32 views0 comments
Jan 292 min read
Key Updates from the 2025 CMS Program Audit Memo
The Centers for Medicare & Medicaid Services (CMS) released its annual Program Audit Update memo, outlining critical changes and updates...
103 views0 comments
Dec 16, 20242 min read
Secret Shopper Calls: Are Your Call Centers Prepared for CMS Monitoring?
The Centers for Medicare & Medicaid Services (CMS) secret shopper program is an essential compliance check for Medicare Advantage and...
108 views0 comments
Nov 26, 20242 min read
CMS Notifies 60 Medicare Advantage Contracts of RADV Audits
On November 14, 2024, the Centers for Medicare & Medicaid Services (CMS) initiated Payment Year (PY) 2018 Risk Adjustment Data Validation...
192 views0 comments
Nov 22, 20243 min read
Dr. Mehmet Oz's Nomination as CMS Administrator: What It Means for the Future of Medicare and Medicaid
President Trump’s nomination of Dr. Mehmet Oz to lead the Centers for Medicare and Medicaid Services (CMS) could signal significant...
303 views0 comments
Oct 17, 20242 min read
Get Ahead of CMS Readiness: Stay Compliant and Prepared for 2025
As the Arizona heat finally dips below 100 degrees, it’s starting to feel like Fall—my favorite season. Halloween is just around the...
98 views0 comments
Sep 27, 20242 min read
The Impact of GLP-1s Medications on Health Plans
Recent statistics from the CDC show more than 38 million people in the US have diabetes and up to 9 million of that number as...
42 views0 comments
Jun 5, 20243 min read
SCAN Health Plan Wins Lawsuit Against CMS
SCANÂ succeeded in United States District Court after a federal judge agreed that the CMS improperly calculated its 2024 Star Ratings.
230 views0 comments
Apr 8, 20248 min read
CMS’s CY 2025 Final Rule: A Quick Summary
CMS’s CY 2025 Final Rule: A Quick Summary
938 views0 comments
Apr 3, 20243 min read
CMS’s CY 2025 Rate Announcement: Key Takeaways
The Centers for Medicare and Medicaid Services (CMS) published the Calendar Year (CY) 2025 Medicare Advantage (MA) Capitation Rates and...
231 views0 comments
Apr 3, 20244 min read
CMS’s Final CY 2025 Part D Redesign Program: The Big Five Takeaways
On April 1, 2024, CMS issued their Final Calendar Year (CY) 2025 Part D Redesign Program Instructions (draft instructions issued...
284 views0 comments
Mar 21, 20241 min read
Have Medicare Advantage Benefits Peaked?
We are pleased to invite you to our free webinar on April 3, 2024 from 1:00 to 2:30 pm EDT.Â
37 views0 comments
Mar 14, 20241 min read
Webinar: Medicare Prescription Payment Plan (M3P) of the Inflation Reduction Act (IRA)
Join our webinar on Mar 19, 2024 at 1:00 PM EDT. Registration Beginning in 2025 all Medicare Part D plans must offer the option to pay...
44 views0 comments
Feb 28, 20242 min read
Rebellis Group merges with Toney HealthCare
Press Release Toney Healthcare, a clinically oriented consultancy and provider of utilization management, care management and quality...
346 views0 comments
Feb 26, 20245 min read
Supplemental Benefits are a Hot Topic with CMS
New Guidance Released on Encounter Data Submission of Supplemental Benefits
149 views0 comments
Jan 19, 20244 min read
The Impact of the CMS Interoperability and Prior Authorization Final Rule
Seismic waves were felt across health plans this week with the finalization of the CMS Interoperability and Prior Authorization Final...
126 views0 comments
Nov 21, 20234 min read
CMS 4205-P Proposed Rule: Top Five Takeaways
On November 15, 2023, CMS issued a proposed rule that proposes revisions to regulations governing Medicare Advantage (MA or Part C), the...
632 views0 comments
Sep 28, 20234 min read
Risk Adjustment: Is Your Organization Ready For The Transition from V24 to V28?
Risk Adjustment: Is Your Organization Ready For The Transition from V24 to V28?
2,007 views0 comments
Sep 19, 20233 min read
GAO Report on Rebates in Medicare Part D Program
The United States GAO (General Accountability Office) released their report on Rebates in the Medicare Part D Program this month...
37 views0 comments
bottom of page