Interpretation of New Medicare Rules and Medical Loss Ratio (MLR)
The Centers for Medicare & Medicaid Services (CMS) has a myriad of rules for different administrative procedures for the Part […]
Compliance Automation
CMS 2024 Call Center Monitoring Performance Metrics for Timeliness – Quarter 4 Study
Ensuring Benchmark Adherence in Call Center Operations The Centers for Medicare & Medicaid Services (CMS) plays a pivotal role in
How to Manage Prescription Drug Event (PDE) Data & Manufacturer Discount Program (MDP) in 2025
Two major provisions of the Inflation Reduction Act (IRA) that take effect in 2025 will require refresher training, even for
CMS 2026 Advance Notice: Key Updates, Payment Changes, and How to Submit Comments
To Usher in the new year, the Centers for Medicare & Medicaid Services (CMS) released a draft of the 2026
Our Key Takeaways from Gartner® Hype Cycle™ for U.S. Healthcare Payers, 2024 Report
The healthcare industry is continuously evolving and with technological advancements, payers seek innovative ways to optimize operations, reduce costs, and
CMS Reminder to Practice Vigilance Against Medicare Fraud, Waste and Abuse(FWA)
On April 15, 2022, the Centers for Medicare & Medicaid Services (CMS) released potential fraud, waste and abuse (FWA) trending
Ensuring Accurate Drug Claims: Insights from CMS Audits and Best Practices
The Centers for Medicare & Medicaid Services (CMS) has added another category of drugs—immunosuppressants—to their national audits in collaboration with
Navigating the Intersection of Payment Integrity and Provider Relations in Healthcare
Payment integrity and provider relations are two critical pillars of a well-functioning healthcare system. When effectively managed, they can lead
CMS Program and Focus Audits: Are You Prepared?
Starting January 2024, the Medicare Parts C and D Oversight and Enforcement Group of the Centers for Medicare & Medicaid
Understanding the 2025 Medicare Part D Re-design: What You Need to Know
The Prescription Drug Program, commonly known as Medicare Part D, is undergoing significant transformations in 2025 due to the Inflation