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...
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Oct 172 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...
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Sep 272 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...
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Jun 53 min read
SCAN Health Plan Wins Lawsuit Against CMS
SCAN succeeded in United States District Court after a federal judge agreed that the CMS improperly calculated its 2024 Star Ratings.
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Apr 88 min read
CMS’s CY 2025 Final Rule: A Quick Summary
CMS’s CY 2025 Final Rule: A Quick Summary
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Apr 33 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...
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Apr 34 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...
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Mar 211 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.
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Mar 141 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...
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Feb 282 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...
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Feb 265 min read
Supplemental Benefits are a Hot Topic with CMS
New Guidance Released on Encounter Data Submission of Supplemental Benefits
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Jan 194 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...
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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...
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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?
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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...
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Sep 12, 20234 min read
AI: The good, the bad, and the ugly in Medicare Advantage
When most of us think about artificial intelligence (AI) in healthcare, we don’t usually think about an algorithm determining if our...
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Sep 1, 20231 min read
Social Determinants of Health and the Updated D-SNP Health Risk Assessment Requirements
Beginning in contract year 2024, there will be CMS changes mandated to Special Needs Plans (SNPs) Health Risk Assessments (HRAs) to...
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Jul 26, 20232 min read
The Inflation Reduction Act of 2022...Winter is Coming
Looking ahead to 2025 for Part D benefits, things don’t look too rosy for health plans. The Inflation Reduction Act of 2022 will be...
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Jun 26, 20233 min read
What is the No Upcode Act?
A bipartisan bill has recently been introduced by Senators Bill Cassidy, MD (R-LA) and Jeff Merkley (D-OR) aimed at addressing risk...
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May 19, 20233 min read
Utilizing the CMS MARx reports for compliance, revenue optimization and member satisfaction
Did you know that CMS provides nearly 100 different reports to Medicare Advantage and Part D plans? These reports cover membership,...
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