The CMS star ratings challenge Annually, the Centers for Medicare & Medicaid Services (CMS) releases star ratings, which measure the quality of care health plans deliver for its members. Launched in 2007, star ratings enable the CMS as well as … Read More
Real-Time Compliance Central
Explore health-plan Appeals & Grievances, Regulatory Compliance and Audit & Monitoring developments
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
Are you in control of your compliance processes?
Compliance maintenance and oversight for health plans can be a resource and time-consuming restraint. Challenges with manual processes, inefficient workflows and frequent compliance audits prove to be disruptive and expensive. Regulatory demands for health plans can result in higher costs, … Read More
2015 CMS Audit Protocol: Your Takeaway
In early February, the CMS released its new audit protocol and process updates for 2015 for Medicare Advantage organizations and Part D sponsors. The new audit protocol memorandum has given way to a lot of speculation and confusion among the … Read More