Top 7 Compliance Gaps That Put Health Plans at Risk
Compliance gaps are costing more than just fines CMS Program Audits are not just a regulatory formality, they are high-stakes […]
Risk Management
Understanding the 2026 Medicare Advantage Rate Announcement
The Centers for Medicare & Medicaid Services (CMS) recently issued the much-anticipated 2026 Medicare Advantage (MA) Rate Announcement. This guidance
Interpretation of New Medicare Rules and Medical Loss Ratio (MLR)
The Centers for Medicare & Medicaid Services (CMS) has a myriad of rules for different administrative procedures for the Part
Future-Proofing Healthcare Data: Leveraging Cloud Platforms for Robust Data Protection
In healthcare, data is the primary keeper of information. Data in healthcare has high sensitivity and large volume, so cybercriminals
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
Strengthening Cyber Resilience: Inovaare’s HITRUST r2 Certification Fortifies Healthcare Data Security
The recent cyberattack on a major healthcare IT vendor, as outlined in the letter from the U.S. Department of Health
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 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,
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