On January 31, 2024, the Centers for Medicare & Medicaid Services (CMS) released a draft of the 2025 Advance Notice describing the Methodological Changes for Calendar Year (CY) 2025 for Medicare Advantage (MA) Capitation Rates and Part C and Part … Read More
Author Archives: manager.inovaare
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
2024 CMS Program Audit Updates: Summary and Insights
Summary of the HPMS Memo Generated by USHER (Inovaare’s AI-powered Compliance Assistant) The Centers for Medicare and Medicaid Services (CMS) issued a memorandum detailing several announcements relating to its 2024 CMS program audit. This includes new requirements for coverage criteria … Read More
Medicare Advantage Overpayments: Are You Ready for RADV Audits?
In recent news, the healthcare industry has been abuzz with significant developments that carry vital lessons for Medicare Advantage health plans, particularly in the areas of compliance and risk assessment. These developments underscore the importance of proactive compliance monitoring and … Read More