BluePeak Advisors, Author at BluePeak Advisors

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

CMS MA Uncategorized

CMS Releases Final Rule on Interoperability and Patient Access

On March 9, 2020, the Centers for Medicare & Medicaid Services (CMS) released the final rule (CMS-9115-F) regarding Interoperability and Patient Access. While CMS issued a fact sheet regarding this rule, this rule…

BluePeak AdvisorsMarch 18, 2020

CMS Part C Part D

Provider Directory Accuracy Monitoring and Use of the National Plan & Provider Enumeration System (NPPES)

On March 11, 2020 the CMS Part C and D User Call focused on Provider Directory accuracy and how the NPPES may support such accuracy. In case you missed it,…

BluePeak AdvisorsMarch 18, 2020

CMS IDS Part C Part D UMS

Universe Monitoring Service Case Study and Service Spotlight

Many of the proposed audit protocol changes for both the 2020 and 2021 audit season included changes to universes. An incomplete and incorrect universe can add 1 point toward your…

BluePeak AdvisorsMarch 18, 2020

CARA CDAG FA Opioids Part D

Is Your Opioid Program Compliant?

In 2019, Medicare introduced new policies for opioid prescriptions in the Medicare Part D prescription drug program to encourage pharmacies, prescribers, and Medicare drug plans to work together with the…

BluePeak AdvisorsMarch 18, 2020

Audits Call Log Review CMS Part C Part D Star Ratings

Accurate Call Classification and Handling-Strategies for Evaluating and Monitoring Your Customer Service Team

The Centers for Medicare & Medicaid Services (CMS) released an HPMS memo on August 20, 2019 providing an overview of the upcoming changes to program audits through 2021. These changes…

BluePeak AdvisorsMarch 18, 2020

Audits CMPs CMS

Civil Money Penalty Actions and Audit Trends

On 2/28/2020, CMS released the Civil Money Penalty (CMP) Enforcement Actions for 2019 Program Audits. Contract year 2019 was the first year of this audit cycle and we have incorporated…

BluePeak AdvisorsMarch 18, 2020