Jen Novitski MBA,BSN,RN’s Post

Don't miss our webinar at 2:30pm where Christy Wilbert (SVP) is reviewing plan year 2025 CMS changes with Karen McDaniel (Compliance Director). In this final rule, we are focusing on current payment structures, including the use of administrative payments, among MA organizations and agents, brokers, and TMPOs, specifically FMOs, that may incentivize some agents or brokers to emphasize or prioritize one plan over another, irrespective of the beneficiary’s needs, leading to enrollment in a plan that does not best fit the beneficiary’s needs and a distortion of the competitive process.

Good Friday Afternoon, MABillers! Note: The more CMS relies on claims data, the more safeguards they need to implement to ensure they are assessing clean data. Garbage in, garbage out. Group urges CMS to address MSSP concerns The National Association of ACOs has submitted comments to the CMS asking the agency to address two major issues within the Medicare Shared Savings Program, which includes the lowering of financial benchmarks over time and the change in the quality reporting process. The group has also urged the agency to exclude from ACOs' financial calculations any payments related to CMS-identified anomalous and highly suspect billings, create a health equity benchmark adjustment, and develop a process that will allow ACOs to request the recalculation of shared. https://lnkd.in/ezjk7HPG #MAB #CMBS #CPSP #MARA #MedicalBilling #Medical #Billing #Reimbursement #Credentials #Training #RemoteWork #Remote

Seeing ⭐️ stars ⭐️ from trying to understand the latest CMS Technical Notes? PQS has recapped the 2025 Medicare Part C and D Star Ratings Technical Notes. Read how MAPD and PDP adherence measure averages are trending for 2025 when you download the PQS summary. https://zurl.co/EnGW

Join me on our next live webinar for a review of 2025 policy changes to Group Medicare and Part D, and how plan sponsors and consultants can best prepare for the coming year. 

⏰ TODAY: Live Webinar "What to Know About the CMS Final Rule" Register and join us at 1 PM: https://bit.ly/4bdInp3 In RetireeFirst's second informational webinar on policy changes effective in 2025, CEO John P. Dulczak and Chief Product Officer Sheela Andrews, Pharm D. will review important updates in the CMS Final Rule and implications to Group Medicare Advantage and Part D plans. Our goal is to inform group plan sponsors and their consultants about the latest changes to the 2025 Medicare landscape and what actionable steps they should consider to prepare for the future and minimize any potential financial impact. Topics We'll Cover: • CMS payment restructuring driving potential changes to premiums and benefits offerings • Impact of the Inflation Reduction Act (IRA) on prescription drug coverage • Changes to Group Medicare Part D phases and financial contributions • Medicare Prescription Payment Plan (M3P) updates • Timelines and key dates • Potential Impact on Retiree Drug Subsidy (RDS) plans #Medicare #GroupMedicare #PartD #InflationReductionAct

What is the Centers for Medicare & Medicaid Services (CMS) Prior Authorization Final Rule in the US and how might it impact patient access? Here, our Petauri colleagues at The Kinetix Group-Powered by Petauri™ (TKG) provide an insightful 3-minute executive briefing on the topic: https://lnkd.in/e6UX2U-6 On 17th January 2024, CMS published the 'CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F)' to improve the electronic exchange of healthcare data and streamline prior authorisation processes. This also adds a new measure for Merit-based Incentive Payment System (MIPS) eligible clinicians. From January 2026, health insurers participating in federal programmes, including Medicare Advantage and Medicaid, must respond to expedited (urgent) prior authorisation requests within 72 hours and standard (non-urgent) requests within 7 days. Insurers must also include their reasons for denying a prior authorisation request and will be required to publicly release data on denial and approval rates for medical treatment. They'll also need to give patients more information about their decisions to deny care. Download a written summary at: https://lnkd.in/eTw374Ji If you'd like to learn more or for an introduction to TKG, email info@mtechaccess.co.uk #Medicare #Medicaid #pharma #patientaccess #marketaccess #pharmaceuticals

Are you ready for #AEP2024? Check out these 5 actionable tips to ensure your documents are prepared with speed, accuracy, and compliance ─ in time for the upcoming AEP. https://lnkd.in/euFe6uBs #medicareadvantage #aep #ANOC #EOC #SB #compliance #documentgeneration

Are you looking to optimize your sIRB processes? Don't miss out on our upcoming webinar where we'll share practical tips and best practices for creating an effective action plan. Register now to secure your spot! #SIRBActionPlan #AdvarraWebinar

Join us on July 11 for our next #webinar where we will explore the types and components of non-submit MSAs, review the legal basis for #MedicareSetAsides, and examine how non-submitted MSAs are a reasonable consideration of Medicare’s interests. Register now at https://lnkd.in/gZxcD6MP #MedicareCompliance #WorkersCompensation #MSPcompliance #MSAs

It's not too late to register for the 2023 Medicare Secondary Payer (MSP) Year in Review happening tomorrow January 11th at 11:00am PST. Here's the link to register https://lnkd.in/eJMZYdiU. #allankoba #msp #claimsmanagement #riskmanagement