In a world of evolving healthcare regulations, compliance isn’t just a mandate – it’s a cornerstone of success for payers and providers. To help organizations gain continual success around compliance, Inovaare, and MongoDB have partnered to bring AI technologies and … Read More
Author Archives: manager.inovaare
Will reporting Medical Loss Ratio Constrain payments to Medicare Advantage plans?
Medicare Advantage plans (MAO) have been increasingly popular with Medicare eligible beneficiaries enrolling 51% of the eligible population in 2023 taking in $454 billion (or 54%) in Medicare spending. Notwithstanding popularity of the MA program, payments to private health plans … Read More
How price transparency in healthcare affects providers, payers and patients
Price transparency is a term that has recently become a leading factor among healthcare payers and providers. It’s a tool used to help patients know the price of a hospital service or product before receiving it. As of January 1, … Read More
Enhancing Delegation Oversight: The Role of Technology Solutions in Health Plans
In the ever-evolving landscape of healthcare, health plans are realizing the importance of leveraging technology solutions to improve their delegation oversight programs. By investing in advanced technology, payers can: Streamline processes Enhance data management Enable real-time monitoring and reporting Improve … Read More
What you should know about Part B drug payments to comply with IRA 2022
The Inflation Reduction Act of 2022 has wide-ranging impact on payments for drugs used by Medicare beneficiaries, whether they are administered in the provider’s office (Part B) or used in the ambulatory setting (Part D). The Centers for Medicare & … Read More
2023 CMS Audit Protocols: What You Need to Know
The Centers for Medicare & Medicaid Services (CMS) has released new audit protocol changes for Medicare and Medicaid plans. These changes, which went into effect on January 1, 2023, are designed to ensure health plans are accurately reporting their costs … Read More