Healthcare
Our Healthcare business serves government regulators, payors, and providers. We perform audit, compliance, and quality assurance work for our government clients. Our work for payors and providers typically involves operational consulting and software applications that leverage artificial intelligence, data analytics, and robotic process automation. Our work across this very complex ecosystem will continue to benefit from our knowledge of the regulatory drivers, the operational complexities and financial challenges, and various information technology developments that will help make the ecosystem more effective.
Are you CMS program audit ready for 2024
Open enrollment activities are a true performance test of your company’s systems and processes. Garnet River Healthcare can get you 2024 CMS program audit ready.
CMS releases updated Plan Communications User Guide (PCUG)
CMS released the updated PCUG 17.4v for Medicare Advantage and Prescription Drug Plans. Changes are minimal, but the release is always a good time for you to revisit what you're doing.
Medicaid and CHIP eligibility
On August 30, CMS sent a letter to all 50 states, requiring a review of their eligibility systems. The impetus for this letter: CMS determined some states’ Medicaid and CHIP eligibility systems are incorrectly configured.
Part C & Part D Enrollment and Eligibility Guidance
On August 15, CMS released the updated guidance for Part C and Part D enrollment and eligibility. Included with the policy and technical changes was a new MA model enrollment request form.
Annual Election Period must-dos for Medicare Advantage Plans
To prepare for Annual Election Period, Medicare Advantage Plans and BPOs need to do more than cover cost and treatment. They need to elevate member experience.
Increase your CMS star ratings
From 2022 to 2023, ratings for MAPs have dropped, with less than half of plans receiving a good rating. Here's you you can increase your CMS star ratings.
Is your CMS program audit ready for 2023
Open enrollment activities are a true performance test of your company’s systems and processes. Garnet River Healthcare can get you 2023 CMS program audit ready.
A lesson about caring learned from an exercise in product branding
This baby elephant not wanting to leave the side of its mom reminds us of a lesson about caring. A good intention with a bad approach can lead to a poor result.
Questions health carriers should ask as they plan for the future
Open enrollments come and go quickly. To ensure customer expectations and compliance requirements are met, here are five questions health carriers should ask.
IV&V Lessons: Five things learned over 30 years
Carl Blanchette is a respected Independent Verification & Validation (IV&V) leader who has learned many lessons over 30 years. Here are his top five.
Caregiver support: How to not lose yourself (when finding yourself) in the service of others
One in five American adults are caregivers. More than a quarter of them struggle with it. New technology platforms can help make caregiver support easier.
Six must-dos as the Medicare Advantage Annual Election Period approaches
Prepping for the Annual Election Period (AEP)? Make sure these six items for Medicare Advantage Plans and BPOs are completed within CMS regulatory timeframes.
RPA adds value across the patient revenue cycle
The typical flow of the patient revenue cycle can be divided into three sections: Patient Access, Care to Claim, and Claim to Payment. RPA adds value to each.
