BluePeak Advisors, Author at BluePeak Advisors

Enrollment ESRD MA

Compliance and Operational Considerations for Medicare Advantage Plans with Increasing Enrollment of End Stage Renal Disease (ESRD) Beneficiaries

For the first time, starting in 2021, the 21st Century Cures Act allows beneficiaries diagnosed with ESRD to enroll in MA plans. These beneficiaries have previously been required to stay on Medicare Fee-for-Service…

BluePeak AdvisorsSeptember 30, 2020

Compliance Medicare Part D

Top 3 Key Regulatory Changes for 2021

There are several noteworthy regulatory changes that require action by Medicare Advantage and Part D Plans in 2021. 1. Provider-Facing Electronic Real-Time Benefit Tool (RTBT) CMS issued a final rule…

BluePeak AdvisorsSeptember 30, 2020

AEP Enrollment

Summary of CMS Changes to Enrollment Requirements for CY2021

Plans may have noticed that CMS has been busy this season making changes to certain Enrollment policies, materials, and software releases to keep up with the changing environment of today…

BluePeak AdvisorsSeptember 30, 2020

CMS Compliance MA Part C Part D

Encounter Data – It’s Not Just Claims Data Anymore.

Background On September 14, 2020 CMS released The Advance Notice of Methodological Changes for Calendar Year (CY) 2022 for Medicare Advantage (MA) Capitation Rates and Part C and Part D…

BluePeak AdvisorsSeptember 21, 2020

COVID19 MA SEPs Star Ratings SUPD

Operational Impact of the Contract Year 2021 Final Rule

Operational Impact of the Contract Year 2021 Final Rule On June 2, 2020 CMS released the Contract Year 2021 and 2022 Policy and Technical Changes to the Medicare Advantage Program,…

BluePeak AdvisorsJune 17, 2020

Case Studies COVID19 Star Ratings

Covid-19, CMS-4190-F, and Stars: Impacts During Uncertain Times-June 2020

Background On April 6, 2020, the Centers for Medicare & Medicaid Services (CMS) issued Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency (CMS-1744-IFC) as an interim…

BluePeak AdvisorsJune 13, 2020

CMS ODAG Part B Uncategorized

Part B Drug Timeliness Monitoring and Management

On May 23, 2019, the Centers for Medicare & Medicaid Services (CMS) published a final rule (CMS-4180-F) which adopted new processing timeframe requirements for preservice organization determinations and plan reconsiderations…

BluePeak AdvisorsJune 13, 2020

Uncategorized

Confused about Data Availability Requirements as a Result of the Interoperability Rule and the Real Time Benefit Tool? BluePeak has you Covered!

Over the course past year, CMS issued several different proposed and final rules that address making certain data available in a real-time or near real-time manner. The table below summarizes…

BluePeak AdvisorsJune 13, 2020

Audits CMS CPE

Benefits of a Compliance Program Effectiveness Audit– Going Beyond Just Meeting the Requirement

CMS guidance requires Medicare Advantage Plans to have an independent audit of their compliance program’s effectiveness each year. Given competing priorities, it may be tempting to conduct a limited or…

BluePeak AdvisorsJune 13, 2020

AEP Audits Enrollment

Annual Enrollment Period (AEP) is Right Around the Corner-From Bid to Enrollment Processing

8 Tips to Ensure Your Plan is Ready After months of hard work and planning, everyone sighed with relief when bids and formularies were submitted earlier this month. But, as…

BluePeak AdvisorsJune 13, 2020