A large segment of our business is focused on pharmacy benefit management companies and assisting you with compliance, operations and interim staffing solutions. Our seasoned Managed Care Pharmacy and Medicare subject matter experts and business managers have worked in all areas of PBMs and understand the challenges facing you with resource limitations, demands on systems, cost containment and client pressures and the onslaught of daily CMS guidance and regulations. Here are some of the services we offer:
BluePeak staff has worked on both sides of the CMS world- as PBM business owners and CMS auditors and regulators. This givesBluePeak the edge of being able to support PBMs, understanding the business challenges that you face, as well as how CMS will audit you and your customers and their processes. This allows for better preparation and maintenance of your compliance programs.
- CMS Mock Audits: One of the most important activities that you can perform to get ready for CMS audits is practice universe pulls and mock CMS audits. BluePeak can assist you with preparation of universes, training of staff to present during the CMS audits and provide subject matter expertise in each of the CMS audit areas. We employ former CMS auditors so that we can execute a mock audit just as CMS will perform the audit. The report will contain information that will allow you to understand exactly where the issues lie and will give you actionable tasks that will allow you to remediate BEFORE CMS identifies the issues.
- CMS Audit Support: During an actual CMS audit, BluePeak can assist with universe review and preparation, document and impact report preparations, coaching of staff and questions to ask or not ask CMS. We can be available onsite to support your teams. After the audit,BluePeak can assist with strategies for corrective actions, Corrective Action Plan (CAP) writing and review, and perform actual remediation work if needed. We can work with the business leads to design project plans, allocate resources and implement corrective actions. We can then perform a validation audit before CMS remediation dates to assure you that you have remediated all items to CMS’ satisfaction.
- Independent Auditor (IA) Validation: BluePeak can assist plans with the new CMS IA validation process. Our team will work with your team to develop a CMS-approved validation work plan, conduct the validation audit and provide the validation report to be shared with CMS.
- Policy and Procedure Review and Writing: We can assist plans in drafting and reviewing policies and procedures—not only from the pure writing standpoint- but assuring that the operations of your organization are compliant and efficient leading to the saving of time and money.
- Staff Training: Many of CMS’ findings are a result of inadequate training of staff in the various business areas. BluePeak can develop customized training programs to meet your needs and ‘train the trainers’ or deliver that training to your staff. Developing training programs can be time and resource consuming, and BluePeak can take the burden off of your hands.
- Healthcare Policy Analysis and Application: BluePeak understands the burden that daily HPMS memos can place on plans, especially small to midsize plans, that may not have the resources to monitor and interpret daily issues. BluePeak monitors, analyzes, and summarizes key Medicare legislation, regulations, and other CMS-issued guidance. We can provide training on policy-related issues for executives, directors, and staff and assesses how policy developments impact specific business and operational areas of your business. We can them develop and implement practical and actionable steps so Medicare plan sponsor clients can proactively address policy-driven operational challenges and business opportunities head-on.
- Interim Staffing: BluePeak can provide plan experienced compliance and operational professionals to assist your staff on when you may need some temporary extra support, or when you have had unexpected resignations. Our team will also assist you with hiring the right people, with the right skill sets for your specific organization.
- Oversight and Monitoring Programs: One of the major reasons plans get into trouble is that they do not have an effective, robust, compliant internal and/or downstream vendor monitoring program. BluePeak can develop or assist you in developing a customized program that is CMS compliant, while able to be operationalized with limited time and human resources from a plan perspective.