BluePeak Advisors, Author at BluePeak Advisors

CMS PACE Part C Part D Winter 2024

Proposed Rule Re: Medicare Program

Proposed Rule Re: Medicare Program; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive…

BluePeak AdvisorsDecember 11, 2024

CMS HCC OIG Winter 2024

Risk-Adjustment Data Validation Readiness: Key Strategies for Compliance

Did you know that there are publicly accessible resources identifying highly scrutinized Hierarchical Condition Category (HCC) codes that may be problematic for your plan? Did you know there’s an annual…

BluePeak AdvisorsDecember 11, 2024

Part D Utilization Management Winter 2024

Navigating the Future of Utilization Management Requirements

As 2024 comes to a close, the Centers for Medicare & Medicaid Services (CMS) Utilization Management (UM) requirements remain as high priority, and 2025 brings with it new considerations for…

BluePeak AdvisorsDecember 11, 2024

IRA MPPP Winter 2024

Medicare Prescription Payment Plan – Are you ready for it?

The Inflation Reduction Act (IRA) introduced several changes to the Medicare landscape. One of the biggest changes that impacts members and plans alike is the Medicare Prescription Payment Plan (MPPP)…

BluePeak AdvisorsDecember 11, 2024

Fall 2024 Part D

Part D Audit Insights for CY2024: Key Takeaways

As the CY2024 audit season wraps up, the Centers for Medicare and Medicaid Services (CMS) has been publishing both draft and final reports for those selected for program audits. We…

BluePeak AdvisorsSeptember 23, 2024

Fall 2024 MOC NCQA

Should Off-cycle MOC Submission Be a Priority, RIGHT NOW?

December 1, 2024, signals closure of the 2024 the National Committee for Quality Assurance (NCQA) Model of Care (MOC) Off-Cycle submission window, but there is still time to update if you…

BluePeak AdvisorsSeptember 23, 2024

Audits Fall 2024

2024 Audit Trends: Special Needs Plans

The 2024 the Centers for Medicare and Medicaid Services (CMS) audit season brought a diverse array of trends for Special Needs Plans (SNPs) yet one consistent and notable emphasis prevailed:…

BluePeak AdvisorsSeptember 23, 2024

CMS Fall 2024 IVR M3P Member Materials Part C Part D SSBCI

2025 Plan Readiness: Are You Prepared?

As you put the final touches on Plan Year 2025 implementation, it is crucial for Medicare plans to stay ahead of the game and be prepared for the changes that…

BluePeak AdvisorsSeptember 23, 2024

Audits CMS Summer 2024

Upcoming IRA Changes for 2025: Key Considerations for Year End Testing

Since its passage, the Inflation Reduction Act (IRA) of 2022 has ushered in changes to the Medicare Part D benefit each contract year (CY) and 2025 is no different. Now…

BluePeak AdvisorsJune 24, 2024

CMS D-SNP MMP Summer 2024

Understanding Dual-Eligible Special Needs Plans (D-SNPs): Your essential guide to types of D-SNPs and the impact of MMPs Sunsetting

In May of 2022, CMS finalized the rule that will sunset Medicare-Medicaid Plans (MMPs). This rule proposes that required states transition their MMP enrollees to integrated Medicare Advantage dual eligible…

BluePeak AdvisorsJune 24, 2024