BluePeak Advisors, Author at BluePeak Advisors

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

CMS February 2023 PACE

PACE Past Performance

CMS continues to move PACE Organizations into alignment with Medicare Advantage plans, and use of past performance to inform request for new or expanded PACE programs is no exception. While…

BluePeak AdvisorsFebruary 3, 2023

IRA November 2022

Part D Operational Implications of the Inflation Reduction Act (IRA) of 2022

On August 16th, the Inflation Reduction Act of 2022 (IRA) was signed into law. The text of the bill is located here and includes changes that, among other things, would…

BluePeak AdvisorsDecember 1, 2022

MA November 2022

Effective Strategies in Claims Quality Auditing

In light of ever rising benefit costs, employers and Medicare Advantage (MA) plans should consider regular claims quality auditing as part of an overall benefits and cost-containment strategy. Claims audits…

BluePeak AdvisorsDecember 1, 2022

MA MCMG Medicare November 2022

Risks in Misclassifying First Tier, Downstream, and Related Entities (FDRs)

There are a number of criteria outlining the oversight of First Tier, Downstream and Related Entities for Medicare Advantage Organizations. Chapters 21 / 9 and 11 of the Medicare Managed…

BluePeak AdvisorsDecember 1, 2022

CMS November 2022 Part D

Minimizing Hospice Billing Concerns

What is the Issue?1 In August 2019, the Department of Health and Human Services Office of Inspector General (OIG) released a report entitled, Medicare Part D is Still Paying Millions…

BluePeak AdvisorsDecember 1, 2022

Fall 2022 Part D

CMS Continues to Scrutinize Part D Claims and Coverage Determinations Process through Program Audits and Notices of Non Compliance

CMS Program Audit season is over and as anticipated, the volume of Program Audits in 2022 increased substantially over prior years. From a Part D perspective, audits have touched almost…

BluePeak AdvisorsSeptember 7, 2022