Every October, the Centers for Medicare & Medicaid Services (CMS) publishes the annual Star Ratings for…
Category: News
Webinar: Key updates to improve coding accuracy in 2025
Improving coding accuracy is a key priority for risk adjustment leaders to drive value for their…
Proactive member engagement strategies to close gaps in Medicare Advantage
With the Medicare Advantage Annual Election Period (AEP) underway, running now through December 7, health plans…
Webinar: What TPAs need to know about payment integrity
The self-insurance industry is witnessing a growing demand for effective payment integrity measures, driven by rising…
3 takeaways for Medicare Advantage plans from the 2025 Star Ratings
Despite no major methodological changes being made this year, overall performance in the 2025 Medicare Advantage…
Case study: Engaging members to apply for the Low-Income Subsidy (LIS)
As Medicare Advantage (MA) plans prepare for the introduction of the Health Equity Index (HEI) in…
Case study: Highmark Wholecare prevents FWA with Claim Pattern Review
Fraud, waste, and abuse (FWA) requires a robust payment integrity program. From compliance requirements and coding…
Busted: The top fraud schemes of Q3 2024
As we approach the end of 2024, fraud, waste, and abuse (FWA) continue to be significant…
Realizing the evolution of FWA prevention and management
As healthcare fraud, waste, and abuse (FWA) schemes continue to evolve, the tactics deployed by health…
Podcast: Driving lasting impact through interoperability
Key updates in 2024 are driving new investments in healthcare interoperability to improve operations and patient…