CMS’ Race to Validate: Navigating the Rapid RADV Era
CMS has launched its Payment Year 2020 Contract-level RADV audit process, giving selected Medicare Advantage health plans access to sampled members and HCCs — with PY2021 audits expected to begin as early as May 2026, creating an unprecedented situation where plans must manage multiple concurrent audits across different payment years. Pareto helps health plans navigate this high-pressure environment by offering prioritized chart retrieval, certified medical coding audits, end-to-end project management, and financial impact quantification — turning a complex compliance sprint into a structured, manageable process.
The Real Job of a Star Ratings Team
A C-Suite leader once asked: “So why does the Stars team need to exist?” They don’t close gaps, chase charts, or run the call center. But in the real world of MA, that team may be the difference between paralysis and performance.
The 3 Biggest Star Takeaways From The 2027 MAPD Rule
The 2027 MAPD Rule is removing 11 Star measures, and the ones being cut are largely the highest-performing ones. This article breaks down what that means for health plan performance, and where leaders should focus their energy in response.
Pareto Intelligence Launches StarIQ to Bring Predictive Intelligence to Medicare Advantage Star Ratings
Pareto StarIQ is a predictive intelligence platform designed to help Medicare Advantage plans leverage predictive insights to execute their best path toward Star Rating improvement.
PY2027 Advance Notice Deep Dive: Impact of Unlinked Supplemental Submissions
CMS proposes eliminating unlinked supplemental records for Medicare Advantage in 2027, but the critical challenge is that official guidance on how to link supplemental encounters to claims has never been published for the MA market. This ambiguity has led to widely varying linking methodologies across plans. This deep dive breaks down the complexities and provides actionable steps for MAOs to navigate this regulatory change.
There’s a Hole in Your Rewards Bucket
Plans often achieve stronger member engagement through personalized rewards and incentive programs. This article explores why many rewards programs fall short and how data-driven targeting can improve participation and health outcomes.
What Is Star Year 2026 CAHPS Data Really Telling Medicare Advantage Plans?
Our analysis of MA CAHPS data highlights state-level performance variation and emerging patient experience trends that could influence Star Ratings results and competitive positioning for health plans.
An Olive Branch and an Alarm Bell: Implications of the Final Rule and Rate Notice on Star Rating Performance
The CMS Final Rule signals higher expectations for Medicare Advantage plans. This article explores how evolving Star Ratings policies are shifting the focus toward measurable outcomes, equity, and strategic quality improvement.
Avoiding Regulatory Scrutiny Through a Strong Risk Adjustment Compliance Culture
Risk adjustment compliance requires more than correcting unsupported diagnoses. This article outlines key areas of risk and shares best practices for building a culture that supports accurate and compliant documentation.
Medicare Advantage Star Ratings: Were you surprised by the Star results?
Admittedly, we were not. Tightening CMS cut points, policy changes, and emerging trends are reshaping how health plans approach quality strategy and performance improvement.