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As Medicare Advantage Prescription Drug (MAPD) plans evolve, health plans face greater complexity in revenue reconciliation. New CMS regulations, updated risk adjustment models, and increased payment integrity scrutiny are raising the stakes—manual processes simply won't keep up. Forward-looking organizations are leveraging technology and automation to ensure accuracy, compliance, and audit readiness.
This comprehensive guide offers a blueprint for mastering compliance, preventing revenue leakage, and staying audit-ready in 2025 and beyond.
Discover how top MA plans use automation, centralized data, and proactive engagement to improve member satisfaction and Star Ratings.
CMS is changing Medicare Advantage audits. Learn how new RADV audit requirements impact your MA plan and how to stay compliant.
OIG is auditing more health plans for Medicare and Medicaid Overpayments at a time when payers are already concerned about lower reimbursements.