Industry Ducks Bullets in 2016 Medicare Advantage Rate Proposal

John Gorman

Friday, February 20th after close of business, the Centers for Medicare and Medicaid Services (CMS), released its 2016 Advance Notice of Medicare Advantage Payment, known affectionately as “the call letter.”

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Risk Adjustment Data Validation (RADV) Audits Just Got Real

John Gorman

Last night the second-largest Medicare Advantage plan in the country, Humana, filed an SEC document detailing a US …

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CMS Releases Part D Drugs and Formulary Requirements

Debra Devereaux

The long awaited revision to the Prescription Drug Benefit Manual Chapter 6 is hot off the press. Many …

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CMS Releases the 2015 Audit Protocol: Critical Next Steps to Avoid Becoming A Casualty of Reasonable Expectations

Betsy Seals

On February 12th, CMS released the 2015 Audit Protocol. The question on everyone’s mind is – what does …

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Countdown to Final Submit

Regan Pennypacker

Today is the final day for current or potential plan sponsors to submit their Medicare Advantage and/or Part …

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In 2015 a Slap on the Wrist Can Be the Kiss of Death

John Gorman

It is truth that in the second term of Democratic administrations, scores get settled between Washington regulators and business …

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Getting Ready for the Bid Season

Mary Kaye Thibert

Since the CMS Medicare Advantage January enrollment numbers did not include the last three days of the Annual …

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