Insights & Articles

Compliance

Pfizer court fight could legalize Medicare copays and unleash ‘gold rush’ in sales

Pharmaceutical companies routinely cover the cost of patient copays for expensive drugs under private insurance. A federal judge could make the practice legal for millions on Medicare as well.

RISE West

Sneak peek at RISE West 2021: 5 hot topics on the agenda at this year’s hybrid event

RISE West 2021 will bring together senior leaders from Medicare Advantage health plans, commercial marketplace sponsors, Part D health plans, providers groups, pharmacy benefit managers, and accountable care organizations to discuss the hot topics facing the industry. We talked to four of the 50 speakers about their sessions to learn what attendees can expect at this year’s hybrid event, which will take place live in Colorado Springs and virtually via livestream August 30-September 2.

Pharmaceutical & Biotech

RISE Radio Episode 9: Dr. Angela Huskey on emerging drug threats, the rise in substance use among the elderly

Angela G. Huskey, PharmD, CPE, senior vice president and chief clinical officer at Millennium Health, joins us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact our three communities: Quality & Revenue; Member Acquisition & Experience; and Social Determinants of Health.

Medicare Market

New RISE Association workgroups tackle Medicare marketing compliance issues, KPIs for marketing and sales

The new workgroups will address issues of most concern to members of RISE’s Medicare Member Acquisition & Experience (MAE) community. Up first, the fallout from Joe Namath’s Medicare television commercials and key performance indicators (KPIs) around marketing and sales.

Revenue & Quality

RISE’s Special Needs Plan Leadership Summit: A live-streaming virtual event to improve member outcomes for hard to reach, at-risk populations

The event, held on June 22-23, is the only non-association yearly gathering for Special Needs Plan (SNP) professionals who are mid- to senior-level management to stay current in a highly regulated and evolving environment.

Population Health & SDoH

Mental health services wane as insurers appear to skirt parity rules during pandemic

A report from the Government Accountability Office paints a picture of an already strained behavioral health system struggling after the pandemic struck to meet the treatment needs of millions of Americans with conditions like alcohol use disorder and post-traumatic stress disorder.

Medicare Market

Medicare marketing alert: Google will now require certification for health insurance advertisers

Without certification, health insurers will no longer be able to run advertisements on Google’s platform after June 2.

Revenue & Quality

When Biden takes office, undoing Trump's health policies won't be easy

President Donald Trump made substantial changes to the nation’s health care system using executive branch authority. But reversing policies that Democrats oppose would take time and personnel resources, competing with other priorities of the new administration.

Medicare Market

An inside look at RISE’s virtual Medicare Secondary Payer Master Class

The live-streaming event will be held on February 9-10, 2021 and will feature 16 sessions and more than 20 industry leaders who will discuss critical topics and developments related to mandatory reporting, legislative updates, conditional payments, and Medicare set-asides.

Compliance

Medicare Secondary Payer Compliance for Beneficiaries: Everything you need to know about RISE’s new virtual seminar

RISE’s new seminar on March 23-24 is designed for Medicare beneficiary representatives, plaintiff attorneys, paralegals, legal assistants, payee representatives, and other advocates of Medicare beneficiaries associated with workers compensation, liability, and no-fault insurance claims. The ultimate purpose of the seminar is to provide attendees with an understanding of how to protect Medicare beneficiaries compliantly. We talked to industry expert Rafael Gonzalez, Esq., about the planned sessions and why you don’t want to miss this groundbreaking seminar.

Revenue & Quality

CMS overhauls Stark Law: What you need to know

The Centers for Medicare & Medicaid Services (CMS) on Friday finalized changes to the Physician Self-Referral Law, more commonly referred to as the Stark Law, which prohibits physicians from making referrals to providers or entities if they have a financial relationship with them. Here is a summary of the changes.

Revenue & Quality

Take it from an expert: Fauci’s hierarchy of safety during COVID

In a new interview with Kaiser Health News, the nation's top infectious disease expert breaks down how to survive the coming months and describes how hard it is when people still insist the coronavirus outbreak is “fake news.”

Revenue & Quality

Have you checked out the RISE Talent Hub?

Learn more about one of the exciting benefits of joining the RISE Association.

Revenue & Quality

COVID-19 update: Fauci warns 400K Americans may die; Azar reauthorizes public health emergency; NEJM editorial slams Trump’s handling of coronavirus

COVID-19 continues to dominate headlines in the wake of President Trump’s diagnosis and hospitalization. Here’s a roundup of the latest news.

Revenue & Quality

RISE’s Special Needs Plan Leadership Summit to explore integration requirements for D-SNPs

William Dede, MPP, health policy associate, Special Needs Plan Alliance, will lead a session on CY21 integration requirements for FIDE-, HIDE-, and D-SNPs during RISE’s upcoming live-streamed virtual event on Oct. 27-28.

RISE National

RISE National 2021 to feature new tracks on digital health care delivery, member experience, and compliance/regulatory updates

Mark your calendars! We are excited to return to Nashville, Tenn. in March for RISE National 2021. Get a first look at the new tracks we’ve already planned for you.

Population Health & SDoH

Spotlight on RISE’s upcoming Special Needs Plan Leadership Summit

Learn best practices to improve outcomes for hard to reach and at-risk populations during a live-streamed virtual event on Oct. 27-28.

Compliance

CompliancePalooza 2020: The impact of COVID-19 on compliance, implications of the 2020 CMS protocols, the future of telehealth, and key strategies to move forward

For the first time, RISE’s 4th annual CompliancePalooza will be a virtual event! The October event will feature two days of high-quality content, timely updates, lively discussion, and networking.

Revenue & Quality

Judge blocks Trump’s anti-transgender health care rule one day before it was to take effect

A New York federal judge on Monday stopped the Trump administration from enforcing a new rule that rolls back nondiscrimination protections for transgender patients.

Compliance

OIG issues COVID-19 fraud alert over health scare scams

Christi A. Grimm, the principal deputy inspector general, warns about “bad actors” preying on people’s fears over COVID-19 and perpetuating fraud schemes.

Compliance

CompliancePalooza 2019 speakers to reveal lessons learned from recent CMS audits

One of the most anticipated sessions at RISE’s upcoming CompliancePalooza is an in-depth look at recent CMS audits featuring a panel of four health plan compliance experts who will talk about their experiences. RISE interviewed two of the panelists ahead of the conference to find out what they would suggest that health plans do to improve audit preparation.

Compliance

CompliancePalooza 2019 keynote interview: Life and career lessons with retired FBI agent Rhonda Glover

Rhonda Glover spent 34 years working for the Federal Bureau of Investigation before retiring last year from a career she loved. She had no choice–the age cut off for agents in federal law enforcement is 57. But she had far too much energy and ambition to leave the working world behind. RISE talked to Glover ahead of CompliancePalooza about what she has learned about leadership and her own career reset as founder and CEO of a training, development, and career coaching firm.

Compliance

CompliancePalooza 2019 speaker spotlight: Gateway Health Plan’s Heather Metz on workplace audit engagement

There is no need to panic if your health plan receives a notification from the Centers for Medicare & Medicaid Services (CMS) that your organization has been selected for a workplace audit— that is, if you're prepared, according to Heather Metz, manager of government compliance for Gateway Health Plan, one of the country’s leading managed care organizations that currently serves Medicare and Medicaid enrollees across five states. RISE got a chance to interview Metz about her strategies for successful workplace audits, one of two topics that she will discuss at CompliancePalooza, Oct. 21-22, in Washington, D.C.

Compliance

CompliancePalooza 2019 promises new innovative ways to approach program audits, strategies to improve FDR oversight

This year’s conference will focus on the effective monitoring of departments and data, and the latest regulatory updates to mitigate compliance risks and ensure a successful Centers for Medicare & Medicaid Services (CMS) audit. Here’s a look at what compliance professionals can expect when RISE gathers on Oct. 21-22 at a brand-new venue—the elegant and historic Omni Shoreham Hotel in Washington D.C.

Compliance

CompliancePalooza takes on the critical issues related to CMS audits, FDR monitoring, and compliance program effectiveness

Health plan leaders and compliance experts from across the country will address hot button issues from 2018 audits and potential changes for the 2019 audit season at CompliancePalooza on Oct. 29-30 in Baltimore.