BluePeak Advisors, Author at BluePeak Advisors

Audits CMS Uncategorized

CMS Discusses Draft 2019 Audit Protocols and More at Conferences

BluePeak Lists Top 5 Changes by Impact to Plan Sponsors Following a flurry of final and proposed rulemaking in April, the Centers for Medicare and Medicaid Services (CMS) discussed program…

BluePeak AdvisorsJune 7, 2018

CMS FWA Part D PDE RAPS

CMS Increases Percentage of Encounter Data on Which MA Plans’ Payments are Based

According to the Final Call Letter, the Centers for Medicare and Medicaid Services (CMS) will increase the percentage of encounter data, on which part of Medicare Advantage plans’ pay is…

BluePeak AdvisorsMay 15, 2018

Podcast

BluePeak Podcast: Initial Thoughts on CMS 2018 Spring Conference

Tune into BluePeak’s newest podcast, to hear Principal Babette Edgar and Senior Consultant Susan Herman discuss their initial thoughts on last week’s CMS 2018 Medicare Advantage & Prescription Drug Plan Spring…

BluePeak AdvisorsMay 14, 2018

Call Letter

BluePeak Releases Summaries and Webinar Covering 2019 Call Letter

Bluepeak Subject Matter Experts (SME) have reviewed the 2019 Call Letter and created the following for your reference. 2019 Call Letter Summary Detailed overview of this year’s changes and what…

BluePeak AdvisorsMay 1, 2018

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