BluePeak Advisors, Author at BluePeak Advisors

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

CMS Medicare Part D

Initial Adoption of Indication-Based Formularies as a Formulary Management Tool

In August of 2018, CMS announced that Medicare Part D Sponsors have the option to use indication-based formularies starting January 1, 2020. Prior to this change, formulary medications were considered…

BluePeak AdvisorsApril 29, 2020

COVID19

Another Symptom of COVID-19-Fraud

CMS issued a Fraud Alert on COVID-19 schemes on March 23 and additional guidance was released via HPMS on April 1st. On April 16th, the National Health Care Fraud Anti-Fraud…

BluePeak AdvisorsApril 18, 2020

Ask the Expert LinkedIn

ICYMI – BluePeak’s Articles Posted Recently On LinkedIn

BluePeak's Summary on COVID-19 Gallagher Special Olympic partnership COVID-19 Medicare Fact Sheet 10 Things Plan need to know about the Proposed Rule Kelly MaKay, RPh, MBA Senior Health Plan Services…

BluePeak AdvisorsMarch 24, 2020

Case Studies UMS

Universe Monitoring Service Case Study

Case Study During the course of a Medicare Program Audit the plan struggled with being able to generate accurate and compliant universes in a timely manner. The plan had experienced…

BluePeak AdvisorsMarch 22, 2020