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

medicare-post

Theme and Focus for Medicare Regulations for Calendar Year (CY) 2023

On February 2, 2022, the Centers for Medicare & Medicaid Services (CMS) released the CY 2023 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (Advance Notice). Below are some … Read More

Optimize Appeal Decisions

Optimizing Appeal Decisions

Medical Directors need relevant Information. Health plans must identify the key pieces of information Medical Directors will need in order to optimize appeal decisions for enrollees, thus improving the member experience. Denials often occur — not because the member didn’t … Read More

Monitor Improper Payments for Part C and Part D with Medicare Audit and Monitoring Software

Monitor Improper Payments for Part C and Part D with Medicare Audit and Monitoring Software

The monthly premium for Medicare Part B rose 14.5%, from $148.50 in 2021 to $170.00 in 2022, which is partly offset by a cost-of-living increase of 5.9% in Social Security benefits. By law, the Medicare Part B monthly premium must … Read More