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How Propensity Modeling Is Transforming Healthcare Personalization and Outcomes
In today’s complex healthcare landscape, data isn’t just numbers—it’s the key to delivering personalized, impactful care. At RISE...
Jul 15, 20251 min read
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 16, 20253 min read
After the Bid: What Comes Next for Medicare Advantage Plans in 2026?
The June 2nd initial bid submission deadline for 2026 has passed, and Medicare Advantage plans were faced with a series of complex...
Jun 5, 20252 min read
CMS Announces Accelerated RADV Delete Deadlines: Is Your Organization Prepared?
The Centers for Medicare & Medicaid Services (CMS) has issued formal deadlines for the submission of closed period deletes to the Risk...
Jun 2, 20252 min read
Top 5 Takeaways for Strengthening Risk Adjustment in 2025
Insights from the 2025 RISE Risk Adjustment Forum As CMS ramps up oversight and plans prepare for V28 and RADV expansion , the 2025 RISE...
May 27, 20252 min read
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...
May 22, 20252 min read
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 1, 20252 min read
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 29, 20251 min read
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 11, 20252 min read
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 4, 20252 min read
Navigating Potential HHS Workforce Reductions
Recent discussions around potential restructuring within the Department of Health and Human Services (HHS), including significant...
Mar 27, 20252 min read
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 19, 20252 min read
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 18, 20252 min read
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 27, 20253 min read
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 7, 20252 min read
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 29, 20252 min read
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
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
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
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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