Real-Time Compliance Central

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

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

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

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

Healthcare organizations establish Compliance Departments with the primary purpose of providing compliance oversight for the organization. Operational teams—such as the Member Services Department and the Appeals & Grievances Department—have significant compliance regulations, so they must know to maintain compliance. This … Read More

Health plans (collectively, “plan sponsors”) that contract with the Centers for Medicare & Medicaid Services (CMS) to provide health services to eligible Medicare beneficiaries are responsible for legal, contractual, and fiduciary obligations whether performed by the plan or those to … Read More