CMS Archives - Page 4 of 9 - BluePeak Advisors

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

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

CMS QBP Star Ratings

Proposed Changes to MA and Part D Prescription Drug Program Quality Rating System from the 2021 and 2022 Policy and Technical Changes Proposed Rule

In the 2021 and 2022 Policy and Technical Changes Proposed Rule, CMS is proposing routine measure updates and an increase in the weight of patient experience/complaints and access measures. It…

BluePeak AdvisorsFebruary 25, 2020

CARA CMS MME OMS Opioids Part D

Ensuring a Pain-free Opioid Safety Strategy

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 AdvisorsDecember 17, 2019

CMS Data Reporting IRE Part C Part D

Got Data?

Independent Review Entity (IRE) Transparency Initiative Plans are continuously looking for data to better understand their appeals outcome. The IRE transparency initiative provides plans with several more tools. During the…

BluePeak AdvisorsDecember 17, 2019

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

CMS PBM

‘Tis ALWAYS the season….for rejected claims analysis.

As year-end approaches, most plans are conducting claims testing to ensure that formularies and benefits are administered correctly on January 1 and beyond. Plans and PBMs alike that have experienced…

BluePeak AdvisorsDecember 17, 2019

CMS PDE

Financial Audits: Lessons Learned

Financial audits are just one of the many types of Medicare Part D audits. Financial audit frequency and awareness continues to increase, and plans are realizing that they must integrate…

BluePeak AdvisorsSeptember 9, 2019