This Is the Year to Get It Right

Regan Pennypacker

Five consecutive years of very similar audit protocol, continuous partnering with sponsors to identify improvements, and numerous best practice/common conditions memos. Where are you in audit readiness? Did you evaluate the items in the 2016 Readiness Checklist sent in November?  I will get back to that! In the meantime, the Centers for Medicare & Medicaid Services (CMS) has started sending audit letters, so we are aware of sponsors and Pharmacy Benefit Managers (PBMs) alike who are prioritizing CMS’ requests. Early bird catches the worm, am I right?  Presumably these plans have larger enrollment, since they will only be required to provide rejected claims for the one month of January.

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Is Value-Based Insurance Design All It’s Cracked Up To Be?

Debra Devereaux

There continues to be a lot of buzz about value-based insurance design (VBID). VBID is the idea that …

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Star Ratings Update: MedPAC Votes to Eliminate Double Bonuses

Melissa Smith

Star Ratings is already a hot topic in 2016, and we’re only one month into the new year.  …

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Breaking the Incompatibility Barrier – Four Keys to Merging Operational Productivity and Compliance

Julie Billman

Can compliance and efficiency co-exist in Operations?  Is there a “right” balance between the two, or could it …

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Risk Adjustment: Proposed Changes & New Regulations

Daniel Weinrieb

At Gorman Health Group (GHG), we pride ourselves on having our fingers on the pulse of what continues …

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Sales 2017 Readiness – Are You Maximizing Your Sales Potential Today?

Carrie Barker-Settles

Here we go again, planning for the upcoming selling season.  Every year it seems to approach more quickly …

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To File or Not To File, That Is the Question

Regan Pennypacker

We’ve made it clear through this blog the Centers for Medicare & Medicaid Services (CMS) is throwing down …

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