BluePeak Advisors, Author at BluePeak Advisors

Compliance & Regulatory Updates Leadership & Organizational Insights Winter 2025

Maintaining Medicare Advantage Audit Readiness in 2026 and Beyond

Aiming for a comprehensive view of plans’ overall compliance, CMS this year is unleashing a host of changes to Medicare Advantage program audits. With the first batch of audit notices…

BluePeak AdvisorsFebruary 25, 2026

Compliance & Regulatory Updates Leadership & Organizational Insights Winter 2025

Preparing for the Future of PACE Audits: A Deep Dive into the Updated 2026 CMS PACE Audit Protocol

The Centers for Medicare & Medicaid Services (CMS) has finalized the 2026 PACE Audit Protocol, PACE Audits | CMS, marking one of the most significant changes to PACE auditing in…

BluePeak AdvisorsFebruary 23, 2026

Compliance & Regulatory Updates Leadership & Organizational Insights Winter 2025

Top Medicare Advantage Plan Strategies for 2026 CMS Audit Changes

Medicare Advantage organizations facing program audits in 2026 will encounter an unusual batch of changes. These changes, revealed in a November CMS memo, are intended to streamline the process and…

BluePeak AdvisorsFebruary 2, 2026

Compliance & Regulatory Updates Leadership & Organizational Insights Winter 2025

Annual CPE Audit – Compliance as a Strategic Asset

Annual CPE audits are required by CMS, but their value goes beyond compliance. These audits assess the effectiveness of your compliance program, identify gaps, and prevent fraud, waste, and abuse.…

BluePeak AdvisorsDecember 3, 2025

Leadership & Organizational Insights Quality & Star Ratings Winter 2025

Stars – Driving Growth, Revenue, and Reputation

Star Ratings are more than numbers—they determine your plan’s financial health, market position, and member loyalty. Every interaction matters, from member experience to clinical outcomes and pharmacy adherence. High ratings…

BluePeak AdvisorsDecember 3, 2025

Medicare Advantage Operations Member Experience / CAHPS Winter 2025

Secret Shopping – See Your Plan Through the Member’s Eyes

Secret shopping is one of the most effective ways to understand how your plan performs in real-world scenarios. By posing as prospective members, these evaluations reveal whether your call center…

BluePeak AdvisorsDecember 3, 2025

CMS Audit Readiness Leadership & Organizational Insights Winter 2025

Readiness Checklist – Your Roadmap to 2026 Compliance

The CMS Readiness Checklist is more than a compliance requirement—it’s your blueprint for success in 2026. This tool ensures your organization is prepared to meet updated regulations, deliver accurate benefits,…

BluePeak AdvisorsDecember 3, 2025

Medicare Advantage Operations PBM & Pharmacy Compliance Winter 2025

Year-End Benefit Testing – Accuracy Before January 1

Year-end testing is essential to validate claims accuracy, ensure compliance with IRA mandates, and confirm PDE reporting integrity. This process guarantees that your systems are prepared for the new contract…

BluePeak AdvisorsDecember 3, 2025

CMS Audit Readiness Compliance & Regulatory Updates Winter 2025

Mock Audits – Stress-Test Before CMS Does

Member service representatives are the heart of a health plan. Their engagement with members significantly influences a member's perceived experience with the plan and their care journey. For a Medicare…

BluePeak AdvisorsDecember 3, 2025

Summer 2025

Navigating CMS Audits: Strategic Preparation for 2026

As you may have heard, the CMS Program Audit season has been slower this year due to contracting award issues affecting the pace. Despite this temporary slowdown, CMS's commitment to…

BluePeak AdvisorsAugust 6, 2025