BluePeak Advisors, Author at BluePeak Advisors

CDAG CMPs ICARs IRE ODAG

Appeals and IRE Data Issues Can Impact Audit Scores, Star Ratings and CMPs

Whether deficiencies are discovered as part of a CMS program audit or a Timeliness Monitoring Project (TMP) review, issues with appeals and Independent Review (IRE) data can impact a plan’s Star Ratings…

BluePeak AdvisorsMarch 6, 2018

CMS CPE Part C Part D

Highlights of CMS-Proposed Changes in Draft 2019 Call Letter

The Centers for Medicare and Medicaid Services (CMS) proposes changes to Star Ratings, validation audits, annual Compliance Program Effectiveness (CPE) audits, Part D opioid overutilization policy, and more in the…

BluePeak AdvisorsMarch 6, 2018

Uncategorized

Ready or not-the 2018 Audit Season is Upon Us…

As Plans Continue to Struggle with the Same Common Conditions, CMS Makes Few Changes from the 2017 to 2018 Audit Protocols As the Centers for Medicare and Medicaid Services (CMS)…

BluePeak AdvisorsMarch 6, 2018

Call Log Review CMS UMS

BluePeak Service Spotlight: Mock Audits with UMS and Call Log Reviews

BluePeak has conducted over 150 CMS mock audits and onsite support projects for clients undergoing actual CMS program audits. We also offer mock audit breakouts, such as our Universe Monitoring…

BluePeak AdvisorsMarch 6, 2018

CMS Medicaid Medicare PDE

ICYMI – BluePeak’s Articles posted recently on LinkedIn

CMS Account Managers May Contact Plans to Assess New Medicare Card Project Readiness PDE Self-Audits Cost At Least One Plan Over $1 Million in Claims Reversals CMS to Conduct Provider…

BluePeak AdvisorsMarch 6, 2018

CMS HPMS Medicare Uncategorized

Decreased HSD Tables Application Requirement Now Leads to CMS Network Adequacy Review Later

Decreased HSD Tables Application Requirement Now Leads to CMS Network Adequacy Review Later Part C applications may have decreased requirements for the submission of a key management staff organizational chart…

BluePeak AdvisorsNovember 29, 2017

Street signs one stating 2018 and pointing left, the other stating 2019 and pointing right

CMS HPMS Medicare Uncategorized

Getting Ready for Early Application Tasks and Understanding 2019 Application Changes

Submit Notice of Intent to Apply (NOIA) Now Each year, the Centers for Medicare and Medicaid Services (CMS) accepts applications from new plan sponsors, as well as existing Medicare Advantage-Prescription…

BluePeak AdvisorsNovember 27, 2017

Audits CDAG CTM FAA PBM TPMA

New Year’s Day is Ultimate Test of New Part D Plan Year Readiness

While most people are singing Auld Lang Sine at midnight on January 1, those of us in the Medicare world are anxiously awaiting the first claims of the plan year…

BluePeak AdvisorsNovember 27, 2017

Audits CMS CPE FDRs

BluePeak Offers Tips for Developing 2018 Risk Assessments and Monitoring and Auditing Work Plans

Annual risk assessments and associated monitoring and auditing work plans are not only required, but also help to ensure your compliance program is efficiently and effectively monitoring and auditing business…

BluePeak AdvisorsNovember 27, 2017

validation audit under a magnifying glass

CMS IA IVA Validation

BluePeak Service Spotlight: Validation Audit Capabilities

From the time you receive the final Centers for Medicare and Medicaid Services (CMS) audit report, you and your team have 150 days to correct deficiencies found during the audit,…

BluePeak AdvisorsNovember 27, 2017