As a Medicare Advantage health plan, one of the main objectives should be to improve CMS Star Ratings. Why? Because the higher the ratings, the larger the bonus payments health plans receive from the government. This incentive exists to motivate … Read More
Real-Time Compliance Central
Explore health-plan Appeals & Grievances, Regulatory Compliance and Audit & Monitoring developments
How to Master CMS Audit Preparation
CMS Audit preparation aren’t something you can cram for at the last minute and expect good outcomes. If health plans aren’t continuously monitoring all CMS universes for compliance issues, not only can errors creep into regulatory compliance tables, it highlights … Read More
Medicare Star Ratings 2021 Changes and Strategies to Address
It has become evident by changes to the Centers for Medicare & Medicaid Services (CMS) Star Rating formulas over the past several years—and especially with changes implemented for the 2021 Plan Year—that member experience and medication adherence is of utmost … Read More
How Do You Like Them Appeals?
Medicare Appeals Best Practices How can health plans improve their Medicare appeals processes? For many health plans serving the Medicare population, they will have to automate more and more of their processes to capitalize on the growing demand for services. … Read More
Forewarned is Forearmed: Prepare for 2021 CMS Audit Protocols Change
While the world is anything but predictable—especially in the age of COVID-19—the Centers for Medicare and Medicaid (CMS) isn’t being cryptic about the forthcoming changes to their audit protocols. But it takes regulatory compliance experts to sift through the minutiae … Read More