Does your current Model of Care coincide with the new requirements?

Peg Novak

The Centers for Medicare and Medicaid Services (CMS) revised the Model of Care (MOC) requirements, reducing core clinical and non-clinical elements from 11 to 4. Subsequently, the National Committee for Quality Assurance (NCQA) revised their scoring guidelines and methodology, based on this change.

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Reasonableness – The Last Chance

Steve Balcerzak

After four tries, some Marketplace health plan applicants have still failed to meet CMS reasonableness standards for 2015. …

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It’s a Marathon – Not a Sprint

Debra Devereaux

Plans will shortly be receiving the Readiness Checklist from CMS. At first glance it looks like just a …

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Important strategies for a plan’s medical management team

Peg Novak

It wasn’t too long ago that the clinical staff and practitioners in the medical management arena of health …

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Another Flood of Good News for Medicare Advantage

John Gorman

Last week the Centers for Medicare and Medicaid Services (CMS) did its annual data dump for the 2015 …

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Gearing up for 2016 – Look Ahead, Plan Ahead

Mary Kaye Thibert

As if you are not busy enough, now is the time to start looking towards both 2016 and the …

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Bombshells from MedPAC on Medicare Advantage Retention

John Gorman

The Medicare Payment Advisory Commission (MedPAC ), the nonpartisan blue-chip Congressional uber-nerds on our favorite entitlement program, met …

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