RISE National 2024

Our experts will be available to discuss priority topics, such as:

Impacts of the RADV Final Rule: The Centers for Medicare & Medicaid Services (CMS) released the final MA risk-adjustment data validation (RADV) rule on January 30, 2023. The final rule sets future RADV policy and creates uncertainty for Medicare Advantage (MA) plans. Avalere is well positioned to provide industry perspectives on the final rule to help plans address operational and financial impacts and mitigate risks posed by RADV audits conducted by CMS and OIG.

Advance Notice Policies: CMS released the 2025 MA and Part D Advance Notice. The proposed changes have major implications to MA plan payment and long-term strategy. Our policy and health plan operations experts support clients in navigating these policy changes to maximize quality and reimbursement in MA and Part D. Our policy plans and operations experts will be monitoring the final rule. We can help plans model the impact of rate setting and risk adjustment changes on these reimbursement on your revenue and assist with mitigating risk and operational challenges.

Inflation Reduction Act (IRA) Implications: Avalere’s experts can help clients understand how implementation of the IRA is impacting payment rates, plan bids, and beneficiary out-of-pocket costs, and forecast the likely impact on formulary negotiations.