Medicare Advantage Compliance

Medicare Advantage Overpayments: Are You Ready for RADV Audits?

In recent news, the healthcare industry has been abuzz with significant developments that carry vital lessons for Medicare Advantage health plans, particularly in the areas of compliance and risk assessment. These developments underscore the importance of proactive compliance monitoring and … Read More

Essential Compliance Checklist for Medicare

Preparing for 2024: Essential Compliance Checklist for Medicare Advantage Organizations

The Annual Election Period (AEP) has ended. Before the Medicare Advantage Open Enrollment Period (MA OEP)[1] begins on January 1, 2024, Medicare Advantage Organizations (MAOs) still have time to review if they are completely ready for a new contract year. … Read More

GenAI in Healthcare

The Transformative Power of GenAI in Compliance and Operations

As a former US healthcare operation management professional, I understand the complexities and dynamic nature of the healthcare compliance landscape. The challenge for healthcare payers and providers is keeping up with the ever-changing regulations and integrating these changes efficiently into … Read More

Medicare Medical Loss Ratio

Will Reporting Medical Loss Ratio (MLR) 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

regulatory-changes-for-pde

Regulatory Changes for PDE Reporting in CY 2024 and Beyond

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

cms-star-ratings-2024

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 reflect upon and restrategize the path forward with newer evaluation dynamics at play. The resulting turbulence has clearly underscored the fact that auto-pilot mode is … Read More