CMS Program Audit Prep: Leveraging Your Appeals & Grievances Software

Happy New Year and ‘tis the season for CMS Program Audits!  In the 2024 CMS Program Audit Updates memo released on December 19, 2023, CMS confirmed their plans to conduct both routine and focused audits of health plans in 2024. The new focused audits will assess compliance with the coverage and utilization management (UM) requirements finalized…

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The Bridge – Volume 11

CMS Important News Releases With a general election, massive increases in COVID-19 cases across the country, and many organizations focusing on the Annual Election Period, you may have missed these important CMS news releases. Advance Notice of Methodological Change for 2022 CMS will calculate 100% of the risk score using the 2020 CMSHCC model (vs.…

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The Bridge – Volume 10

We Wish You a Successful and Compliant AEP Season! While we are all in the throes of Annual Enrollment Period (AEP), Madena is looking to support you by dedicating a newsletter to upcoming critical activities that can easily be overlooked during this busy time. CMS Low Income Subsidy Processing Have you reached out to your…

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Medicare Advantage Member Accounting & Reconciliation Conference

On January 26th & 27th, Madena will be sponsoring the Medicare Advantage Member Accounting & Reconciliation conference at the Sanibel Harbour Marriott Resort & Spa in Fort Myers, Florida. The Madena booth will be manned by veteran enrollment analysts and industry regulatory experts. Come stop by and meet the team, we’d be delighted to answer…

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