BluePeak Advisors, Author at BluePeak Advisors

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

CMPs CMS IRA Medicare NABA NONC Part D Spring 2024

The Importance of Medicare Marketing Material Development and Review, New changes coming and 2024 finding examples

Member materials are an important part of the Medicare member experience with a plan. Each year as Plan Sponsors finalize their product bid filing, CMS releases the upcoming plan year…

BluePeak AdvisorsMarch 29, 2024

CMS December 2023

The Centers for Medicare & Medicaid Services: 2024 Readiness Checklist for Medicare Advantage Organizations, Prescription Drug Plans

The Centers for Medicare & Medicaid Services (CMS) released the CY2024 Medicare Parts C and D Readiness Checklist on October 13, 2023. Although this is a busy time of year,…

BluePeak AdvisorsDecember 11, 2023

CMS December 2023 HHS SSBCI

Special Supplemental Benefits for the Chronically Ill: 2025 Proposed Rule Impacts to Consider

Believe it or not, it is already time to start thinking about plan benefits for contract year 2025. Plan sponsors continue to look for ways to grow membership, modify benefit…

BluePeak AdvisorsDecember 11, 2023

December 2023 Opioids Part D

Is Your Part D Stars Program Ready to Ring in the New Year?

On April 12, 2023, Centers for Medicare & Medicaid Services (CMS) published the 2024 Final Rule that postponed moving the three polypharmacy measures (Concurrent Use of Opioids and Benzodiazepines, Polypharmacy…

BluePeak AdvisorsDecember 11, 2023

CMS December 2023 IRA

Inflation Reduction Act (IRA): 2024 Summary of Changes and Oversight Considerations

The Centers for Medicare & Medicaid Services (CMS) has released significant guidance to support the Inflation Reduction Act (IRA) provisions that impacts Medicare enrollees, health plans, pharmacy benefit managers (PBM)…

BluePeak AdvisorsDecember 11, 2023

CMS December 2023 Utilization Management

2024 Final Rule Changes: Impacts on Utilization Management Tools and Proposed Changes for 2025.

The Final Rule 2024 is one of the most substantive in recent years, with clarifications, codifications to existing rules and new requirements! Plans need to be well prepared this year…

BluePeak AdvisorsDecember 11, 2023