Medicare Appeals & Grievances

How Do You Like Them Appeals?

Medicare Appeals Best Practices How can health plans improve their Medicare appeals processes? For many health plans serving the Medicare population, they will have to automate more and more of their processes to capitalize on the growing demand for services. … Read More

Health Plan Compliance Solutions

Forewarned is Forearmed: Prepare for CMS Audit Rule Changes

While the world is anything but predictable—especially in the age of COVID-19—the Centers for Medicare and Medicaid (CMS) isn’t being cryptic about the forthcoming changes to their audit rules. But it takes regulatory compliance experts to sift through the minutiae … Read More


Are you in control of your compliance processes?

Compliance maintenance and oversight for health plans can be a resource and time-consuming restraint. Challenges with manual processes, inefficient workflows and frequent compliance audits prove to be disruptive and expensive. Regulatory demands for health plans can result in higher costs, … Read More


2015 CMS Audit Protocol: Your Takeaway

In early February, the CMS released its new audit protocol and process updates for 2015 for Medicare Advantage organizations and Part D sponsors. The new audit protocol memorandum has given way to a lot of speculation and confusion among the … Read More

CMS Program Audit Protocols

2015/2016 CMS Program Audit Protocols and Process Updates

CMS program audit evaluate the performance of the Medicare Advantage/Prescription drug plans (MAPDs) and prescription drug plans (PDPs) that provide health care coverage to Medicare eligible beneficiaries. In February of 2015 CMS published the audit protocols that will be utilized … Read More

CMS Program Outreach

Reasonable Outreach: Are you missing what CMS expects?

The Centers for Medicare & Medicaid Services (CMS) on April 20th of 2016 released several job aids in order to assist plan sponsors with improving their operations and ensuring compliance with CMS requirements. These job aides are based on common … Read More