LATEST INDUSTRY UPDATES
April, 2024
Deciphering the 2025 Final Rule: CMS Unveils Sweeping Medicare Advantage Changes. CMS ushered in a new era for Medicare Advantage Part C and Part D programs with the unveiling of the CY 2025 Final Rule. ATTAC’s compliance experts reviewed the final rule and crafted a high-level analysis of noteworthy changes and potential ramifications for MA organizations. 

Expanded Telehealth Access: Medicare Rule Changes Impact Access, Health Equity and Risk Scores. As telehealth utilization continues to climb, it's become increasingly important to consider its impact on member risk scores. CMS frequently revises policies that influence coding, documentation, billing, and the eligibility of practitioners to provide telehealth services.

Elevate Your Compliance Training Program: Proven Methods to Measure and Enhance Effectiveness. In our work with numerous health plans, we’ve developed best practices to measure and evaluate training effectiveness. Here are a few tried-and-true methods.

Webinar Replay |Value-based Care is a Team Sport: How Providers Can Operationalize Risk Adjustment Initiatives. Explore the power of collaboration between providers and health plans to achieve accurate risk-adjusted compensation. Watch the replay here. 

Given the new, deeper scrutiny from CMS, Medicare Advantage plans can rely on ATTAC’s experienced compliance team to:

  • Test application of UM criteria
  • Review plan/FDR denial letters
  • Review UM committee criteria
  • Prepare medical directors/staff 
  • Test downstream delegates
  • Perform a UM-focused mock audit
  • Help refine denial language
  • Review IPA communications
  • Evaluate data universes

CMS aims to assess UM-related performance of plans serving 88% of beneficiaries this year, and it intends to accomplish this through both routine program audits and focused audits. According to compliance experts, the volume of audit activity since CMS began sending engagement letters in late February suggests the agency is eager to meet its goal, but it may not like what it finds.

In the article, ATTAC's CEO Steve Arbaugh discusses why transparency for beneficiaries is critical.