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CMS Kicks Off PY2019 RADV Audits: What Medicare Advantage Organizations Must Know Now
On Friday, June 13th, CMS officially initiated PY2019 Medicare Advantage RADV audits , marking a significant escalation in oversight and...
Jun 163 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
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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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Supplemental Benefits are a Hot Topic with CMS
New Guidance Released on Encounter Data Submission of Supplemental Benefits
Feb 26, 20245 min read
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Risk Adjustment: Is Your Organization Ready For The Transition from V24 to V28?
Risk Adjustment: Is Your Organization Ready For The Transition from V24 to V28?
Sep 28, 20234 min read
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What is the No Upcode Act?
A bipartisan bill has recently been introduced by Senators Bill Cassidy, MD (R-LA) and Jeff Merkley (D-OR) aimed at addressing risk...
Jun 26, 20233 min read
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Calendar Year 2024 Rate Announcement
On March 31, 2023, the Centers for Medicare & Medicaid Services (CMS) issued its Announcement of Calendar Year (CY) 2024 Medicare...
Apr 7, 20233 min read
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CMS Issues Final Rule to Hold MAOs Accountable for Risk Adjustment Practices
On January 30th, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS),...
Jan 31, 20232 min read
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How Medicare Advantage Plans Will or Will Not Succeed, With Betsy Seals
Here’s a big thing that Betsy Seals makes clear in this show: Big companies can be successful in Medicare Advantage (MA)—and I mean...
Dec 1, 20221 min read
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2023 MA and Part D Final Rate Announcement Includes 8.5% Revenue Boost, Increased Star Ratings
The Centers for Medicare and Medicaid Services (CMS) published the Announcement of Calendar Year (CY) 2023 Medicare Advantage (MA)...
Apr 12, 20223 min read
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Improper Payments in Government Programs: Has The Other Shoe Already Dropped?
Co-Authored by Betsy Seals, CEO and Martha Goodlin, RN Over the past several years, we have seen an increase in CMS, OIG, and DOJ...
Oct 13, 20212 min read
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