Simplifying Prior Authorization Processes in HealthcareÂ
CMS’s comprehensive updates focus on improving beneficiary access, promoting transparency, and streamlining PA processes. Here’s what you need to know […]
Healthcare Compliance and Regulatory Insights
Medicare Prescription Payment Plan (M3P) Implementation: Key Considerations for Part D Plan Sponsors and PBMs
The upcoming Medicare Prescription Payment Plan (M3P), set to launch in January 2025, marks a significant shift in Medicare’s approach
Streamlining Medicare Advantage Organizations Member Communication: A Guide to CMS’s Model Materials for CY 2025
Every year, Medicare Advantage Organizations (MAO)1 must update their member communication materials, such as the Annual Notice of Change (ANOC),
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
Capitation Rates Announcement for Medicare Advantage Plans for CY 2025
The Centers for Medicare & Medicaid Services (CMS) officially announced capitation rates for Medicare Advantage (MA) plans for CY 2025
Changes for Prescription Drug Encounter (PDE) Data in 2024
The Centers for Medicare & Medicaid Services (CMS) has been processing Part D drug claim data via the Drug Data
Strategies for Proper Payments for Part B and Part D Drugs
Until the enactment of the Medicare Modernization Act (MMA) in 2006[1], the Centers for Medicare & Medicaid Services does not
Medicare Part D Risk Adjustments and Bidding Instructions for 2025
The Centers for Medicare & Medicaid Services (CMS) uses the Hierarchical Condition Category (CMS-HCC) medicare risk adjustment model to determine
Navigating the 2025 Advance Notice: Implications for Medicare Advantage and Part D
On January 31, 2024, the Centers for Medicare & Medicaid Services (CMS) released a draft of the 2025 Advance Notice
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