From Medicare Advantage News - As CMS carries out a new policy of reviewing Medicare Advantage plans’ entire provider networks for adequacy if they request service area expansions, MAN has learned that plans are dealing with a stricter-than-ever exceptions process and in some cases are having to drop legacy counties in order to expand. Read more
From Medicare Advantage News - When it comes to managing risk and closing gaps in care, the solution isn’t always as simple as targeting the costliest members. Health plans and their vendor partners can implement tailored strategies that include sharing risk with providers, leveraging community partners and using data to identify those members at the highest risk for noncompliance and costly claims, according to two speakers who gave separate presentations at the Medicare Advantage and… Read more
From Medicare Advantage News - Nineteen of the 23 program audits conducted in 2015 of Medicare Advantage plans that were reviewed by CMS since the beginning of 2016 have resulted in the plan involved being directed to hire an independent auditor (IA) to verify that the problems found have been corrected, a CMS official said at a conference session June 16. This figure and other comments made by Doreen Gagliano, technical advisor in the Division… Read more
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