The recent cyberattack on a major healthcare IT vendor, as outlined in the letter from the U.S. Department of Health and Human Services, serves as a sobering reminder of the vulnerabilities facing the healthcare industry. With patient data and provider … Read More
Author Archives: manager.inovaare
Changes for Prescription Drug Encounter Data in 2024
The Centers for Medicare & Medicaid Services (CMS) has been processing Part D drug claim data via the Drug Data Processing System (DDPS) since inception of Part D in 2006. PDE provide the foundation for revenue reconciliation with drug plan … Read More
Proper Payments for Part B and Part D Drugs
Until the enactment of the Medicare Modernization Act (MMA) in 2006[1], the Centers for Medicare & Medicaid Services does not cover most outpatient prescription drugs under Part B (“Part B drugs”). However, some drugs self-administered by Medicare beneficiaries at home … Read More
HCSC Acquires Cigna’s Medicare Businesses and CareAllies
Health Care Service Corporation (HCSC) has entered into a definitive agreement to purchase Cigna’s Medicare Advantage, Medicare Supplemental Benefits, Medicare Part D, and CareAllies businesses for $3.3 billion. This strategic move is set to enhance HCSC’s capabilities and extend its … Read More
2024 CMS Program and Focus Audits: Are You Prepared?
Starting January 2024, the Medicare Parts C and D Oversight and Enforcement Group of the Centers for Medicare & Medicaid Services (CMS) will begin conducting both Program Audits and focused audits of Medicare Advantage organizations (MAO) to assess compliance with … Read More
Understanding the 2025 Medicare Part D Re-design: What You Need to Know
The Prescription Drug Program, commonly known as Medicare Part D, is undergoing significant transformations in 2025 due to the Inflation Reduction Act (IRA) of 2022. These changes mark a pivotal shift from its original structure in 2006. Understanding these changes … Read More