On October 13, 2023, the Centers for Medicare & Medicaid Services (CMS) published the Readiness List for CY 2024. This has been a very useful tool for Medicare Advantage Organizations (MAO) to check their readiness to fulfill requirements in the … Read More
Real-Time Compliance Central
Explore health-plan Appeals & Grievances, Regulatory Compliance and Audit & Monitoring developments
2024 Medicare Advantage and Part D Star Ratings: Key Observations and Takeaways
2024 Star Ratings, which CMS released on October 13, 2023 has forced the industry to deeply introspect and re-strategize the path forward with newer evaluation dynamics at play. The resulting turbulence has clearly underscored the fact that auto-pilot mode is … Read More
The Inovaare – MongoDB Partnership: Unlocking Excellence in Healthcare Compliance
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
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.[1] Notwithstanding the 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: Today, we will explore the reasons why health plans must prioritize … Read More