So, what does “Unreasonable Delay” really mean in Federally Facilitated Marketplaces?

Steve Balcerzak

As expected, CMS has been sending correction notices to health plans about their networks. Also, as expected, some plans have received a second rejection of their response to the first rejection. Now, time is limited since final corrections are due by September 4. Health plans are asking CMS to give them some idea about how to meet CMS expectations.

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The Medicare ACO Demos Are a Mess. Here’s What it Means for Health Plans.

John Gorman

This week, another Medicare Pioneer Accountable Care Organization Demonstration site, longtime GHG client Sharp Healthcare in San Diego announced …

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Sales Allegations – What is the best practice?

Betsy Seals

It’s just about that time of year again. Yes, you’ve got it – Sales Allegation time. During AEP, …

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The Clock is Ticking…

Janet Fina

If you are a veteran of Medicare Risk Adjustment reporting, you are probably in high gear planning or …

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Hospice Guidance Turns 180 Degrees

Debra Devereaux

After 70 Senators signed a protest bill and the hue and cry from hospice providers, patients and prescribers …

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The Model of Care’s Interdisciplinary Care Team

Paul Alexander

The Centers for Medicare & Medicaid Services (CMS) has outlined expectations for Model of Care (MOC) for Medicare …

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Health Plan Strategists: Fish Where the Fishes Is — in LTSS

John Gorman

One of the best pieces of advice I ever got in business was to “fish where the fishes is”, …

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