Inflation Reduction Act

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

Affordable Care Act

ACA Health Plans — Key considerations for staying relevant

A perspective on recent industry shifts influencing ACA plan operations in states, which are yet to adopt ACA Medicaid expansion Health Exchange plans covered under ACA (Accountable Care Act) witnessed 36% enrollment growth between 2021 and 2023. This is the … Read More


Proactive Healthcare Compliance and the Importance of Continuous Monitoring

Proactive healthcare compliance refers to an approach where an organization seeks to identify and address compliance risks before they become a problem. This approach can have several benefits, including:  Overall, proactive compliance can help health plans manage compliance risks more … Read More


Streamline Your Parts C and D Reporting with Universe Scrubber 

Medicare Advantage Organizations (MAOs) and Prescription Drug Plan (PDP) sponsors have to submit Parts C and D reports to the Centers for Medicare & Medicaid Services (CMS) annually. The reporting data are quarterly. These reports are to show:  Costs of … Read More


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) 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