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 […]
Regulatory Compliance
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
What you should know about Part B drug payments to comply with IRA 2022
The Inflation Reduction Act of (IRA) 2022 has wide-ranging impact on payments for drugs used by Medicare beneficiaries, whether they
ACA Health Plans — Key considerations for staying relevant
A perspective on recent industry shifts influencing ACA plan operations in states, which are yet to adopt ACA Medicaid expansion
Is your Medicare Advantage Organization Ready for Compliance with Regulatory Changes in 2023?
Annual Election Period (AEP) is about two weeks away when Medicare Advantage Prescription Drug Plans (MAPD) will be signing up
CY 2022 CMS Program Audit Protocols Changes
The Centers for Medicare & Medicaid Services (CMS) launched a new cycle of program audits in February 2022. Multiple Medicare
Theme and Focus for Medicare Regulations for Calendar Year (CY) 2023
On February 2, 2022, the Centers for Medicare & Medicaid Services (CMS) released the CY 2023 Advance Notice of Methodological