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CMS RADV Audit Expansion Signals Urgent Need for Plan Readiness
CMS has just announced a major expansion of its audit program for Medicare Advantage (MA) plans—shifting from sampling a few contracts to...
1 day ago2 min read
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NEW! CMS Enforcement Actions – April 2025 Update
In April 2025, the Centers for Medicare & Medicaid Services (CMS) issued a significant round of enforcement actions impacting a wide...
May 12 min read
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CMS Releases HPMS Memo on Risk Adjustment Data Submission Deadlines for PY 2025–2027
CMS has issued an HPMS memo  titled: “Deadlines for Submitting Risk Adjustment Data for Use in Risk Score Calculation Runs for Payment...
Apr 291 min read
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Is Your Organization Ready for the Full Implementation of V28? Here’s What You Need to Know
The Centers for Medicare & Medicaid Services (CMS) have introduced significant updates to the Hierarchical Condition Category (HCC) risk...
Apr 112 min read
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From Civil Penalties to $62M Settlements – Why Audit Readiness Matters More Than Ever
As of January 2025, the Centers for Medicare & Medicaid Services (CMS) imposed civil monetary penalties on several Medicare Advantage and...
Apr 42 min read
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Navigating Potential HHS Workforce Reductions
Recent discussions around potential restructuring within the Department of Health and Human Services (HHS), including significant...
Mar 272 min read
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CMS and Medicare Advantage: What’s Next for Publicly Traded and Local Plans?
The Centers for Medicare & Medicaid Services (CMS) is sharpening its focus on Medicare Advantage (MA) plans, with special attention on...
Mar 192 min read
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Aligning Implementation Milestones: A Major Key to a Seamless Medicare Advantage Launch
Successful Medicare Advantage (MA) implementation depends on more than just hitting deadlines—it requires alignment across all health...
Mar 192 min read
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Key Factors Driving C-SNP Growth and Why Health Plans Should Invest
The Medicare Advantage market is ever-evolving, with Chronic Condition Special Needs Plans (C-SNPs) emerging as a notable growth area....
Feb 273 min read
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Top Compliance Takeaways from HCCA – Is Your Plan Ready?
Coming out of the HCCA Compliance Conference this week, one thing is clear—compliance and regulatory oversight are evolving rapidly....
Feb 72 min read
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Key Updates from the 2025 CMS Program Audit Memo
The Centers for Medicare & Medicaid Services (CMS) released its annual Program Audit Update memo, outlining critical changes and updates...
Jan 292 min read
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Secret Shopper Calls: Are Your Call Centers Prepared for CMS Monitoring?
The Centers for Medicare & Medicaid Services (CMS) secret shopper program is an essential compliance check for Medicare Advantage and...
Dec 16, 20242 min read
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CMS Notifies 60 Medicare Advantage Contracts of RADV Audits
On November 14, 2024, the Centers for Medicare & Medicaid Services (CMS) initiated Payment Year (PY) 2018 Risk Adjustment Data Validation...
Nov 26, 20242 min read
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Dr. Mehmet Oz's Nomination as CMS Administrator: What It Means for the Future of Medicare and Medicaid
President Trump’s nomination of Dr. Mehmet Oz to lead the Centers for Medicare and Medicaid Services (CMS) could signal significant...
Nov 22, 20243 min read
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Get Ahead of CMS Readiness: Stay Compliant and Prepared for 2025
As the Arizona heat finally dips below 100 degrees, it’s starting to feel like Fall—my favorite season. Halloween is just around the...
Oct 17, 20242 min read
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The Impact of GLP-1s Medications on Health Plans
Recent statistics from the CDC show more than 38 million people in the US have diabetes and up to 9 million of that number as...
Sep 27, 20242 min read
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SCAN Health Plan Wins Lawsuit Against CMS
SCANÂ succeeded in United States District Court after a federal judge agreed that the CMS improperly calculated its 2024 Star Ratings.
Jun 5, 20243 min read
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CMS’s CY 2025 Final Rule: A Quick Summary
CMS’s CY 2025 Final Rule: A Quick Summary
Apr 8, 20248 min read
1,014 views
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CMS’s CY 2025 Rate Announcement: Key Takeaways
The Centers for Medicare and Medicaid Services (CMS) published the Calendar Year (CY) 2025 Medicare Advantage (MA) Capitation Rates and...
Apr 3, 20243 min read
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CMS’s Final CY 2025 Part D Redesign Program: The Big Five Takeaways
On April 1, 2024, CMS issued their Final Calendar Year (CY) 2025 Part D Redesign Program Instructions (draft instructions issued...
Apr 3, 20244 min read
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