CMS Archives - Page 2 of 9 - BluePeak Advisors

CMS December 2023 Utilization Management

2024 Final Rule Changes: Impacts on Utilization Management Tools and Proposed Changes for 2025.

The Final Rule 2024 is one of the most substantive in recent years, with clarifications, codifications to existing rules and new requirements! Plans need to be well prepared this year…

BluePeak AdvisorsDecember 11, 2023

CMS February 2023 PACE

PACE Past Performance

CMS continues to move PACE Organizations into alignment with Medicare Advantage plans, and use of past performance to inform request for new or expanded PACE programs is no exception. While…

BluePeak AdvisorsFebruary 3, 2023

CMS November 2022 Part D

Minimizing Hospice Billing Concerns

What is the Issue?1 In August 2019, the Department of Health and Human Services Office of Inspector General (OIG) released a report entitled, Medicare Part D is Still Paying Millions…

BluePeak AdvisorsDecember 1, 2022

CMS

OIG finds MAOs Inappropriately Denying Requests for PA and Payment, CMS agrees to Issue Stricter Guidance and update Audit Protocols and Auditor Training

In late April, the U.S. Department of Health and Human Services Office of Inspector General (OIG) released their detailed findings concerning inappropriate denials of prior authorization (PA) requests and payment…

BluePeak AdvisorsMay 9, 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

CMS Compliance PBM PDE

The PDE Submission Deadline is Rapidly Approaching-Don’t Assume a High Acceptance Rate Translates to PDE Accuracy

The 2021 PDE submission deadline is June 29, 2022. Plans must attest to the accuracy of their submitted PDE records prior to CMS’ financial reconciliation. The challenge is that many…

BluePeak AdvisorsFebruary 12, 2022

CMS Medicare Part D

Two Rules With Potential Part D Rebate Access Impact

Two rules have the potential to impact how Part D price concessions and pharmaceutical rebates are managed and how these changes, when implemented, will subsequently impact a Part D sponsor’s…

BluePeak AdvisorsFebruary 9, 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

CMS HPMS Part D

Annual Transition Policy and Attestation Submission to CMS

The Centers for Medicare and Medicaid Services (CMS) requires, as part of the formulary submission process, each plan sponsor complete the Transition Policy Attestation through the formulary submission module in…

BluePeak AdvisorsFebruary 9, 2022

ACA CMS CSR FFE

Significant Changes Proposed for Qualified Health Plans

The Centers for Medicare & Medicaid Services (CMS) recently released a proposed rule titled “Patient Protection and Affordable Care Act; Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving…

BluePeak AdvisorsJuly 12, 2021