The Annual Election Period (AEP) has ended. Before the Medicare Advantage Open Enrollment Period (MA OEP)[1] begins on January 1, 2024, Medicare Advantage Organizations (MAOs) still have time to review if they are completely ready for a new contract year. … Read More
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The Transformative Power of GenAI in Compliance and Operations
As a former US healthcare operation management professional, I understand the complexities and dynamic nature of the healthcare compliance landscape. The challenge for healthcare payers and providers is keeping up with the ever-changing regulations and integrating these changes efficiently into … Read More
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 in $454 billion (or 54%) in Medicare spending.[1] Notwithstanding the popularity of the MA program, payments to private health plans … Read More
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 has been a very useful tool for Medicare Advantage Organizations (MAO) to check their readiness to fulfill requirements in the … Read More
The Inovaare – MongoDB Partnership: Unlocking Excellence in Healthcare Compliance
In a world of evolving healthcare regulations, compliance isn’t just a mandate – it’s a cornerstone of success for payers and providers. To help organizations gain continual success around compliance, Inovaare, and MongoDB have partnered to bring AI technologies and … Read More