BluePeak Advisors, Author at BluePeak Advisors

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

Summer 2024 Utilization Management

2024 Utilization Management (UM)- Focused Audits: Lessons Learned

The annual Centers for Medicare and Medicaid Services (CMS) Audit Season has been in full swing since the beginning of the year with a focus on Utilization Management. CMS is…

BluePeak AdvisorsJune 24, 2024

Audits Medicare Part D Spring 2024 Utilization Management

What Risk Does the new TERM Table Really Pose?

Have you heard about the new table initially required in the CMS Utilization Management (UM)-Focused audits? Also, known as “Table 7”, Plans need to ensure an ability to report accurate…

BluePeak AdvisorsMarch 29, 2024

Audits CMS Spring 2024

What we know so far about 2024 Utilization Management Focused Audits

On April 12, 2023, the Centers for Medicare & Medicaid Services (CMS) released the 2024 Final Rule in the Federal Register (2024 Final Rule). Among other provisions, the Final Rule…

BluePeak AdvisorsMarch 29, 2024

IRA Part D Spring 2024

The Part D Tongue Twister and Brain Teaser also known as the Medicare Prescription Payment Plan

The Inflation Reduction Act (IRA) was signed into law in August 2022 with the goal of expanding Part D benefits, lowering drug costs, and improving the sustainability of the Medicare…

BluePeak AdvisorsMarch 29, 2024