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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
SCAN Health Plan Wins Lawsuit Against CMS
SCAN 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
CMS’s CY 2025 Final Rule: A Quick Summary
CMS’s CY 2025 Final Rule: A Quick Summary
Apr 8, 20248 min read
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
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
Have Medicare Advantage Benefits Peaked?
We are pleased to invite you to our free webinar on April 3, 2024 from 1:00 to 2:30 pm EDT.
Mar 21, 20241 min read
Webinar: Medicare Prescription Payment Plan (M3P) of the Inflation Reduction Act (IRA)
Join our webinar on Mar 19, 2024 at 1:00 PM EDT. Registration Beginning in 2025 all Medicare Part D plans must offer the option to pay...
Mar 14, 20241 min read
Rebellis Group merges with Toney HealthCare
Press Release Toney Healthcare, a clinically oriented consultancy and provider of utilization management, care management and quality...
Feb 28, 20242 min read
Supplemental Benefits are a Hot Topic with CMS
New Guidance Released on Encounter Data Submission of Supplemental Benefits
Feb 26, 20245 min read
The Impact of the CMS Interoperability and Prior Authorization Final Rule
Seismic waves were felt across health plans this week with the finalization of the CMS Interoperability and Prior Authorization Final...
Jan 19, 20244 min read
CMS 4205-P Proposed Rule: Top Five Takeaways
On November 15, 2023, CMS issued a proposed rule that proposes revisions to regulations governing Medicare Advantage (MA or Part C), the...
Nov 21, 20234 min read
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
GAO Report on Rebates in Medicare Part D Program
The United States GAO (General Accountability Office) released their report on Rebates in the Medicare Part D Program this month...
Sep 19, 20233 min read
AI: The good, the bad, and the ugly in Medicare Advantage
When most of us think about artificial intelligence (AI) in healthcare, we don’t usually think about an algorithm determining if our...
Sep 12, 20234 min read
Social Determinants of Health and the Updated D-SNP Health Risk Assessment Requirements
Beginning in contract year 2024, there will be CMS changes mandated to Special Needs Plans (SNPs) Health Risk Assessments (HRAs) to...
Sep 1, 20231 min read
The Inflation Reduction Act of 2022...Winter is Coming
Looking ahead to 2025 for Part D benefits, things don’t look too rosy for health plans. The Inflation Reduction Act of 2022 will be...
Jul 26, 20232 min read
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
Utilizing the CMS MARx reports for compliance, revenue optimization and member satisfaction
Did you know that CMS provides nearly 100 different reports to Medicare Advantage and Part D plans? These reports cover membership,...
May 19, 20233 min read
2024 Final Rule: Top 5 Take Aways for Sales and Marketing Teams
Now that Medicare Advantage plans, FMOs, and other Third-Party Marketing Organizations (TPMOs) have had a chance to review the 2024 Final...
May 9, 20232 min read
CMS 2024 Final Rule: Top Takeaways
The Centers for Medicare and Medicaid Services (CMS) published Final Rule 4201-F (88 FR 22120) on April 12 revising the Medicare...
May 3, 20233 min read
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