Medicare Part D Risk Adjustments and Bidding Instructions for 2025
Updated October 2026: this post covers the Part D risk adjustment model and bidding instructions for contract year 2025. Those
Navigating the 2025 Advance Notice: Implications for Medicare Advantage and Part D
On January 31, 2024, the Centers for Medicare & Medicaid Services (CMS) released a draft of the 2025 Advance Notice
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
CMS Program and Focus Audits: Are You Prepared?
Updated October 2026: this post describes the CMS program audit protocols as of 2024. For current requirements, see 2026 CMS
Understanding the 2025 Medicare Part D Re-design: What You Need to Know
Updated October 2026: this post describes the Medicare Part D redesign as it took effect in 2025. The redesigned benefit
2024 CMS Program Audit Updates: Summary and Insights
Updated October 2026: this post describes the CMS program audit protocols as of 2024. For current requirements, see 2026 CMS
Medicare Advantage Compliance: Lessons from High-Stakes Penalties
In recent news, the healthcare industry has been abuzz with significant developments that carry vital lessons for Medicare Advantage plans,
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
Preparing for 2024: Essential Compliance Checklist for Medicare Advantage Organizations
The Annual Election Period (AEP) has ended. Before the Medicare Advantage Open Enrollment Period (MA OEP)[1] begins on January 1, 2024,
The Transformative Power of GenAI in Healthcare Compliance and Operations
As a former U.S. healthcare operation management professional, I understand the complexities and dynamic nature of the healthcare compliance landscape.
Will Reporting Medical Loss Ratio (MLR) 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
Regulatory Changes for PDE Reporting in CY 2024 and Beyond
On October 13, 2023, the Centers for Medicare & Medicaid Services (CMS) published the Readiness List for CY 2024. This
