Navigating the Complexities and Opportunities of the Medicare Prescription Payment Plan for Health Plans
The Centers for Medicare & Medicaid Services (CMS) introduced the Medicare Prescription Payment Plan (M3P) as a part of the Inflation Reduction […]
Ensuring a Successful Open Enrollment: Key Areas for Healthcare Payers & TPAs
As healthcare payers and third-party administrators (TPAs) gear up for the open enrollment period (OEP) and annual enrollment period (AEP), ensuring a […]
The Impact of Non-Compliance for Healthcare Organizations
In the intricate realm of healthcare, healthcare organizations confront the daunting challenge of adhering to stringent regulations. Non-compliance can precipitate severe financial […]
Critical Prep Areas for 2024 Utilization Management (UM)-Focused Audits
The 2024 Medicare Advantage and Part D Final Rule (CMS-4201-F) introduced new constraints on Utilization Management (UM) policies, particularly prior authorization, effective […]
5 Signs You’re Not Ready for Your CMS Part C and Part D Program Audit Now
In the complex landscape of healthcare administration, being prepared for a CMS (Centers for Medicare & Medicaid Services) Parts C and Part […]
Celebrating Data Privacy Day: Where Security Meets Innovation in Claims Processing
January 28th marks an important date for all sectors dealing with sensitive data, especially in the healthcare industry. It’s Data Privacy Day, […]
Checklist for Excellence: 7 Key Elements for an Effective Health Plan Compliance Program
In the intricate realm of healthcare, navigating compliance requirements is essential for health plans aiming to succeed amidst evolving regulations. A well-crafted […]
Michael Friel, Compliance Officer speaks on healthcare compliance regulations and how to remain apprised of industry changes
This month we are speaking to Michael Friel, Compliance Officer, on the latest healthcare compliance regulations and how he keeps on top of the evolving industry of healthcare […]
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