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 […]
Regulatory Compliance
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
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,
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
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
How Price Transparency in Healthcare Affects Providers, Payers and Patients
Price transparency is a term that has recently become a leading factor among healthcare payers and providers. It’s a tool