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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

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

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

Audits CDAG CPE FA ODAG SNP-MOC

New Audit Protocols are Coming in 2021

On December 6, 2019 CMS issued the HPMS Memo titled “Proposed Collection for New Medicare Part C and Part D Program Audit and Industry-Wide Part C Timeliness Monitoring Project (TMP)…

BluePeak AdvisorsFebruary 5, 2020

Audits CD CMS OD

Best Practices in Plan and Prescriber Interactions-Improving the Organizational Determination and Coverage Determination Process

The Organizational Determination (OD) and Coverage Determination (CD) process can be a source of frustration for members, prescribers and plans. The updates to Chapter 13 and 18 highlight the expectation…

BluePeak AdvisorsDecember 17, 2019

Audits CMS MA-PD PDE

Audit Experiences Underscore the Importance of the Additional Beneficiary Information Initiatives (ABBI) Database

Prior to 2019, plan sponsors were required to make an effort determine whether an immunosuppressant should be paid under Part D or Part B based upon information they had or…

BluePeak AdvisorsSeptember 9, 2019

Audits CMS HPMS Medicaid Medicare

Highlights of Proposed 2020 Audit Protocols

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 AdvisorsSeptember 9, 2019

Audits CMPs HIPAA OCR

Is Your Organization Doing All You Can to Detect, Prevent and Correct HIPAA Violations?

On April 30, 2019, Health and Human Services (HHS) published a final rule in which they are exercising their discretion in how they apply regulations concerning the assessment of Civil…

BluePeak AdvisorsJune 11, 2019