Decreased HSD Tables Application Requirement Now Leads to CMS Network Adequacy Review Later Part C applications may have decreased requirements for the submission of a key management staff organizational chart…
Submit Notice of Intent to Apply (NOIA) Now Each year, the Centers for Medicare and Medicaid Services (CMS) accepts applications from new plan sponsors, as well as existing Medicare Advantage-Prescription…
Annual risk assessments and associated monitoring and auditing work plans are not only required, but also help to ensure your compliance program is efficiently and effectively monitoring and auditing business…
From the time you receive the final Centers for Medicare and Medicaid Services (CMS) audit report, you and your team have 150 days to correct deficiencies found during the audit,…
During the 2017 audit season, BluePeak observed increased CMS increased scrutiny on plans and their First Tier, Downstream and Related Entities (FDRs), as well as repeated Common Conditions. With limited changes from…
On October 26, President Donald Trump declared the nation’s opioid epidemic a public health emergency. The opioid epidemic is the deadliest drug epidemic in American history. Deaths from opioid overdose…
Background CMS began capturing encounter data several years ago from plans. The long- term intent of using this data was for risk adjusted payment purposes, as well as to be…
The Centers for Medicare & Medicaid Services (CMS) is now considering deficiencies found from one-third financial audits for potential enforcement actions, including Civil Money Penalties (CMPs), according to a memo…
From February to August, the Centers for Medicare & Medicaid Services (CMS) conducted the second round of online provider directory reviews of 64 Medicare Advantage Organizations (MAOs). CMS reviewed online…
Bid approved – check. Member materials sent to printer – check. What other items should be on your radar over the next few months? The Centers for Medicare and Medicaid…