CMS Revises the 2019 A&G Guidance

CMS Revises the 2019 A&G Guidance By Jen Sousa, Vice President In February 2019, CMS released the long-awaited updates to Chapter 13 of the Medicare Managed Care Manual and Chapter 18 of the Medicare Prescription Drug Benefit Manual. These changes were released as...

Getting Clarification from CMS

Getting Clarification from CMS By Jen Sousa, Vice President Between the Code of Federal Regulations (CFR), Part C and Part D guidance manuals, and HPMS memos, there are literally thousands of pages of material to memorialize CMS’ requirements and expectations. Yet we...

Industry-Wide ODAG and CDAG Monitoring Activity

Industry-Wide ODAG and CDAG Monitoring ActivityBy Jen Sousa If you have been through a CMS program audit in 2015 or 2016, you have gone through the rigors of a timeliness review of your Part C Organization Determinations, Appeal, and Grievances (ODAG) and Part D...