medicare-advantage

Is your Medicare Advantage Organization Ready for Compliance with Regulatory Changes in 2023?

Annual Election Period (AEP) is about two weeks away when Medicare Advantage Prescription Drug Plans (MAPD)[1] will be signing up new enrollees by the thousands. According to the Centers for Medicare & Medicaid Services (CMS), enrollment in MAPD keeps rising. In … Read More

healthcare-compliance

Healthcare Compliance Partner, A&G Vendor or Both?

When health plans want compliance support, and technical solutions that drive healthcare compliance, can they turn to one company to do it all? The short answer is Yes! Healthcare organizations increasingly need compliance support, given the amount of federal and … Read More

Healthcare Risk Management

Risk Management Essential for Healthcare Organizations 

Medicare Advantage Organizations (MAOs) are private health plans that contract with the Centers for Medicare & Medicaid Services (CMS) to provide a menu of health care services similar to those offered under Original Medicare. They pay for the services with monthly … Read More

audit-odag

Discover what’s new for Program Audit ODAG Protocol in 2022

The Centers for Medicare & Medicaid Services (CMS) launched a new cycle of CMS program audits in February 2022. Even though we’re six weeks from the end of the 2022 cycle, there’s still time to review the new and changed … Read More

fraud

CMS Reminder to Practice Vigilance Against Medicare Fraud, Waste and Abuse

On April 15, 2022, the Centers for Medicare & Medicaid Services (CMS) released potential fraud, waste and abuse (FWA) trending data collected from Medicare Advantage Prescription Drug Plans (plan sponsors) for fourth quarter 2021. The most prominent suspect was misrepresentation … Read More

cms-program-audit

CY 2022 CMS Program Audit Protocols Changes

The Centers for Medicare & Medicaid Services (CMS) launched a new cycle of program audits in February 2022. Multiple Medicare Advantage Prescription Drug Plans (MAPDs) have already received notification of their selection. CMS anticipates a total of 25 plan organizations … Read More