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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
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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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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
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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
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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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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
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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
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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
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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
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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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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
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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
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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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It’s That Time Again: MTM Program Submission
2024 Submission The 2024 Medication Therapy Management Program (MTMP) submission date is June 7 and the MTMP attestations are due June...
Apr 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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Call Center Optimization Has Major Impacts on 2023 Star Ratings
In 2020, when CMS shifted the star rating system from being heavily weighted on clinical care and health outcomes to one that was...
Mar 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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CMS 4201-P Proposed Rule: The Big Five Takeaways
On December 14, 2022, CMS issued a proposed rule that puts forth revisions to regulations governing Medicare Advantage (MA or Part C),...
Jan 13, 20232 min read
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2023 Program Audit Updates
2023 CMS Program Audit Updates
Dec 6, 20222 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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