CMS has introduced key RADV audit updates that raise the bar for health plan accountability. This blog breaks down what payers need to know, including changes to sampling, extrapolation, and error rate calculations, and how to stay audit-ready. Learn how automation, data quality, and GenAI can help reduce risk and improve compliance with the new CMS RADV audit requirements.
Every year, the Centers for Medicare & Medicaid Services (CMS) requires Medicare Advantage Organizations (MAOs) and Prescription Drug Plans (PDP)
The Centers for Medicare & Medicaid Services (CMS) has added another category of drugs—immunosuppressants—to their national audits in collaboration with
The Centers for Medicare & Medicaid Services (CMS) officially announced capitation rates for Medicare Advantage (MA) plans for CY 2025
The Centers for Medicare & Medicaid Services (CMS) has been processing Part D drug claim data via the Drug Data
On January 31, 2024, the Centers for Medicare & Medicaid Services (CMS) released a draft of the 2025 Advance Notice
Starting January 2024, the Medicare Parts C and D Oversight and Enforcement Group of the Centers for Medicare & Medicaid
Medicare Advantage Organizations (MAOs) and Prescription Drug Plan (PDP) sponsors have to submit Parts C and D reports to the
