BluePeak Advisors, Author at BluePeak Advisors

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

Claims September 2023

Classifying An Enrollee Billing Complaint as a Grievance, Coverage Request, or Both?

When an enrollee contacts the plan about a provider’s bill, it can be challenging to determine if the enrollee’s issue should be classified as an inquiry or processed under the…

BluePeak AdvisorsSeptember 7, 2023

FDR MA Part D September 2023

Changes to CMS Requirements for Translation and Alternate Formats

To ensure effective communication and meaningful access, Medicare Advantage (MA) and Prescription Drug Plans (PDPs) have been obligated to follow various, occasionally interconnected directives for translating member documents into different…

BluePeak AdvisorsSeptember 7, 2023

PBM September 2023

2024 National Average Monthly Bid Amount Impact

On July 31, 2023, Centers for Medicare & Medicaid Services (CMS) released the National Average Monthly Bid Amount (NAMBA) for contract year (CY) 2024. For 2024, the national average bid…

BluePeak AdvisorsSeptember 7, 2023

June 2023 TPMO

Third Party Marketing Organization (TPMO) Requirements – Not just a Sales Department Responsibility

If it seems as though the Centers for Medicare and Medicaid Services (CMS) has increased its focus, oversight and scrutiny on the marketing practices of some agents and brokers for…

BluePeak AdvisorsJune 1, 2023

IRA June 2023

Inflation Reduction Act (IRA) Drug Rebate Program and Drug Price Negotiation

CMS has been very active in releasing significant guidance to support the Inflation Reduction Act (IRA) provisions for the Part Drug Inflation Rebate and the Drug Price Negotiation program. Earlier…

BluePeak AdvisorsJune 1, 2023

CDAG CPE FA June 2023 ODAG SNP-MOC

2023 CMS Program Audit Trends and Key Details: What We Know So Far

On November 30, 2022, the Centers for Medicare and Medicaid Services (CMS) Medicare Parts C and D Oversight and Enforcement Group (MOEG) announced the 2023 program audit updates. CMS is…

BluePeak AdvisorsJune 1, 2023

News Alert

Calling All SNP Plans

Is your Special Needs Plan (SNP) due for a 2025 Model of Care (MOC) submission? With a due date of February 2024, we encourage you to not wait to review…

BluePeak AdvisorsMay 24, 2023

February 2023 Medicare Part A Part B Part C Part D

BluePeak provides fresh insight into the CMS Proposed Rule for 2024

On December 27, 2022, the Centers for Medicare & Medicaid Services (CMS) published proposed rule (CMS_FRDOC_0001-3474) in the Federal Register. If finalized, this proposed rule would revise the Medicare Advantage…

BluePeak AdvisorsFebruary 3, 2023