Audits Archives - BluePeak Advisors

Audits Fall 2024

2024 Audit Trends: Special Needs Plans

The 2024 the Centers for Medicare and Medicaid Services (CMS) audit season brought a diverse array of trends for Special Needs Plans (SNPs) yet one consistent and notable emphasis prevailed:…

BluePeak AdvisorsSeptember 23, 2024

Audits CMS Summer 2024

Upcoming IRA Changes for 2025: Key Considerations for Year End Testing

Since its passage, the Inflation Reduction Act (IRA) of 2022 has ushered in changes to the Medicare Part D benefit each contract year (CY) and 2025 is no different. Now…

BluePeak AdvisorsJune 24, 2024

Audits Consultant Corner Summer 2024

Consultant Corner: Updates to the Plan Communication User Guide That Require Attention

Meryl Chick is a Consultant with BluePeak Advisors, a division of Gallagher Benefit Services, Inc. Are you monitoring the Batch Completion Status Summary (BCSS)? If the answer is no and…

Meryl ChickJune 24, 2024

Audits Medicare Part D Spring 2024 Utilization Management

What Risk Does the new TERM Table Really Pose?

Have you heard about the new table initially required in the CMS Utilization Management (UM)-Focused audits? Also, known as “Table 7”, Plans need to ensure an ability to report accurate…

BluePeak AdvisorsMarch 29, 2024

Audits CMS Spring 2024

What we know so far about 2024 Utilization Management Focused Audits

On April 12, 2023, the Centers for Medicare & Medicaid Services (CMS) released the 2024 Final Rule in the Federal Register (2024 Final Rule). Among other provisions, the Final Rule…

BluePeak AdvisorsMarch 29, 2024

Audits Consultant Corner Spring 2024

Consultant Corner: “See One, Do One, Teach One”

Lisa B. Barker MBA, BSN, RN, CCM is a Senior Consultant, Part C Lead with BluePeak Advisors, a division of Gallagher Benefit Services, Inc. “See One, Do One, Teach One”…

Lisa BarkerMarch 13, 2024

Audits Fall 2022

CMS Announces Audits Targeting Fraud, Waste, and Abuse Beginning October 2022

Beginning October 2022 and continuing throughout 2023, CMS, in conjunction with the Plan Program Integrity Medicare Drug Integrity Contract (PPI MEDIC), will initiate three National Audits, six Self-Audits and four…

BluePeak AdvisorsAugust 25, 2022

Audits CMS Medicare Part D

Will Your Grievance Resolution Letters Stand Up in an Audit?

Across the Medicare Advantage and Part D industry, Plans are nervous about how their grievance resolution letters will present and stand the test in a CMS Program Audit. BluePeak Advisors…

BluePeak AdvisorsFebruary 18, 2022

Audits CMS Medicaid Medicare

Program Audit Consistency Teams (PACTs)

In the ‘2022 Program Audit Process Overview’1 document, the Centers for Medicare & Medicaid Services (CMS) shared that they will send engagement letters to initiate routine audits beginning February 2022 through…

BluePeak AdvisorsFebruary 9, 2022

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