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 […]
Healthcare Operations
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
Medicare Advantage Overpayments: Are You Ready for RADV Audits?
In recent news, the healthcare industry has been abuzz with significant developments that carry vital lessons for Medicare Advantage health
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,
The Transformative Power of GenAI in Healthcare Compliance and Operations
As a former U.S. healthcare operation management professional, I understand the complexities and dynamic nature of the healthcare compliance landscape.
2023 CMS Audit Protocols: What You Need to Know
The Centers for Medicare & Medicaid Services (CMS) has released new audit protocol changes for Medicare and Medicaid plans. These
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
Proactive Healthcare Compliance and the Importance of Continuous Monitoring
Proactive healthcare compliance refers to an approach where an organization seeks to identify and address compliance risks before they become
Streamline Your Parts C and D Reporting with Universe ScrubberÂ
Medicare Advantage Organizations (MAOs) and Prescription Drug Plan (PDP) sponsors have to submit Parts C and D reports to the
Risk Management Essentials for Healthcare OrganizationsÂ
Medicare Advantage Organizations (MAOs) are private health plans that contract with the Centers for Medicare & Medicaid Services (CMS) to