BluePeak Advisors, Author at BluePeak Advisors

Audits CDAG CPE FA ODAG SNP-MOC

New Audit Protocols are Coming in 2021

On December 6, 2019 CMS issued the HPMS Memo titled “Proposed Collection for New Medicare Part C and Part D Program Audit and Industry-Wide Part C Timeliness Monitoring Project (TMP)…

BluePeak AdvisorsFebruary 5, 2020

CARA CMS MME OMS Opioids Part D

Ensuring a Pain-free Opioid Safety Strategy

In 2019, Medicare introduced new policies for opioid prescriptions in the Medicare Part D prescription drug program to encourage pharmacies, prescribers, and Medicare drug plans to work together with the…

BluePeak AdvisorsDecember 17, 2019

Fraud NHCAA

New Fraud Schemes

In October, the National Health Care Anti-Fraud Association (NHCAA) held its annual training conference that spotlighted emerging fraud schemes. In addition to updates on the brace, genetic testing, and foot…

BluePeak AdvisorsDecember 17, 2019

CMS Data Reporting IRE Part C Part D

Got Data?

Independent Review Entity (IRE) Transparency Initiative Plans are continuously looking for data to better understand their appeals outcome. The IRE transparency initiative provides plans with several more tools. During the…

BluePeak AdvisorsDecember 17, 2019

Audits CD CMS OD

Best Practices in Plan and Prescriber Interactions-Improving the Organizational Determination and Coverage Determination Process

The Organizational Determination (OD) and Coverage Determination (CD) process can be a source of frustration for members, prescribers and plans. The updates to Chapter 13 and 18 highlight the expectation…

BluePeak AdvisorsDecember 17, 2019

CMS PBM

‘Tis ALWAYS the season….for rejected claims analysis.

As year-end approaches, most plans are conducting claims testing to ensure that formularies and benefits are administered correctly on January 1 and beyond. Plans and PBMs alike that have experienced…

BluePeak AdvisorsDecember 17, 2019

CMS PDE

Financial Audits: Lessons Learned

Financial audits are just one of the many types of Medicare Part D audits. Financial audit frequency and awareness continues to increase, and plans are realizing that they must integrate…

BluePeak AdvisorsSeptember 9, 2019

HEDIS MPF Star Ratings

It is Always a Good Time to Think About Star Ratings

As you checked your plan data that will be displayed on Medicare Plan Finder (MPF) for accuracy during the recent second plan preview, were you happy with your Star Ratings?…

BluePeak AdvisorsSeptember 9, 2019

Audits CMS MA-PD PDE

Audit Experiences Underscore the Importance of the Additional Beneficiary Information Initiatives (ABBI) Database

Prior to 2019, plan sponsors were required to make an effort determine whether an immunosuppressant should be paid under Part D or Part B based upon information they had or…

BluePeak AdvisorsSeptember 9, 2019

Audits CMS HPMS Medicaid Medicare

Highlights of Proposed 2020 Audit Protocols

The Centers for Medicare & Medicaid Services (CMS) released an HPMS memo on August 20, 2019 providing an overview of the upcoming changes to program audits through 2021. These changes…

BluePeak AdvisorsSeptember 9, 2019