How policy changes for CY 2026 impact Medicare Advantage plans
The Centers for Medicare & Medicaid Services (CMS) finalized CMS-4208-F on April 4, 2025 and the final rule is published […]
Compliance Monitoring
Interpretation of Medicare Rules and Medical Loss Ratio
The Centers for Medicare & Medicaid Services (CMS) has a myriad of rules for different administrative procedures for the Part
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
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
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
2024 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
2024 CMS Program Audit Updates: Summary and Insights
Summary of the HPMS Memo Generated by USHER (Inovaare’s AI-powered Compliance Assistant) The Centers for Medicare and Medicaid Services (CMS)
Medicare Advantage Compliance: Lessons from High-Stakes Penalties
In recent news, the healthcare industry has been abuzz with significant developments that carry vital lessons for Medicare Advantage plans,