BluePeak Advisors, Author at BluePeak Advisors

Audits CMS

Contract Year 2021 Monitoring of Posted Comprehensive Formularies

On November 2, 2020, CMS released the results of the CY2020 Monitoring of Posted Comprehensive Formularies or their Posted versus Approved (PvA) analysis. For the CY2020 analysis, CMS announced that…

BluePeak AdvisorsNovember 24, 2020

Compliance

Avoiding a Perfect Storm-Proactive Testing and Claims Oversight is Key

The most effective way for any plan to avoid member disruption and compliance risks for the new plan year is to establish a process to validate the accuracy of the…

BluePeak AdvisorsNovember 24, 2020

Interoperability

Interoperability– Everything You Wanted to Know

As the date for compliance with the Interoperability Rule draws closer, BluePeak answers all of your questions, to help you stay in the know. 1 Question: I read the required…

BluePeak AdvisorsNovember 24, 2020

CMS

Perfect Storm

The last quarter of 2020 will likely be the most significant and the most challenging testing season plans have experienced. Unfortunately, there may be a perfect storm brewing that is…

BluePeak AdvisorsNovember 3, 2020

Audits

2019 Program Audits Reflect Continued Improvement

Reprinted with AIS Health permission from the October 1, 2020, issue of RADAR on Medicare Advantage CMS’s latest overview of program audits showed continued improvement among Medicare Advantage and Part…

BluePeak AdvisorsOctober 9, 2020

CMS FA

Annual Testing More Important than Ever

The most effective way for any Plan to mitigate any compliance risks for the new plan year is to strategize a process to validate the accuracy of the formulary and…

BluePeak AdvisorsSeptember 30, 2020

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