Regulatory

NCQA Updates Health Plan Accreditation for 2020

Improvements to evaluating health plans and increasing transparency. Focus on implementing standards and achieving outcomes. Reducing the administrative burdens for health plans. These are all prominent goals for NCQAs Health…

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TEFCA: The On-Ramp to Interoperability

The U.S. Department of Health and Human Services (HHS) has been given the colossal task of creating a Trusted Exchange Framework and Common Agreement (TEFCA) that supports a network-to-network exchange…

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NCQA Distinction: Helping Coordinate LTSS

More than 3 million people in the United States rely on Medicaid for Long-Term Services and Support (LTSS) in nursing homes, home care, and community-based settings. LTSS supports people with…

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State Privacy Laws on the Rise

Privacy laws are being implemented around the world as most of us in the United States watch from our desks. At first the impacts were minimal, then Google was hit…

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The Struggle for Accuracy in Provider Directories

The issue Provider directories are often fraught with errors and inaccuracies, which can lead to hefty CMS fines and sanctions against health plans. As many health plans know from personal…

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Trump’s Blueprint on International Drug Pricing; What to Expect

The U.S. always stood out as a different healthcare system. Well, maybe not anymore. The Trump Administration released an International Drug Pricing blueprint in 2018 and it was received with…

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Discount Safe Harbor Proposed Rule: How Process Works and What does it mean?

July 2019 Update As first reported by The Wall Street Journal and Axios on July 11, 2019, the Trump Administration has decided to abandon implementation of the proposed Discount Safe…

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Are you ready? Preparing for the new EU MDR implementations

New regulations are in effect, with transition periods ending in 2020 and 2022 Medical and in vitro diagnostic device manufacturers in the EU are likely aware of big changes in…

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Managing Regulatory Operations from a Compliance Perspective

Co-authored by Aubrey Elmore, Senior Consultant PCMA By the year 2025, the government-sponsored share of health spending is projected to increase and account for 47% of national health care expenditures,…

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