CMS Archives - Page 9 of 9 - BluePeak Advisors

Opioid Epidemic Spotlights Health Plans’ FWA Investigations

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…

Michelle Rigby, CFENovember 3, 2017

CMS PDE

Encounter Data – It’s Not Just Claims Data Anymore.

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…

Nancy EricksonOctober 17, 2017

CMPs CMS Medicare News Uncategorized

CMS Expands Penalties in 2017: One-Third Financial Audit Findings Will Cost You More This Year

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…

Kim Mullins, MBASeptember 15, 2017

CMS Medicare News Uncategorized

You’re Going to Want BluePeak’s Online Provider Directory Review Service

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…

BluePeak AdvisorsSeptember 15, 2017

ANOC/EOC CMS Compliance CPE CTM HPMS PBM Uncategorized

2018 is Around the Corner – Are You Ready?

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…

Kim Mullins, MBASeptember 15, 2017

Audits CMS Compliance Part C Part D Past Performance Uncategorized

Past Performance, Encounters and Misclassifications, Oh My!

CMS denies applications due to Past Performance scores, encounter data volume is growing, and misclassification of appeals and grievances continues to be an issue. BluePeak tells you what you need…

Kim Mullins, MBASeptember 15, 2017

CMS CPE CTM Part D

CMS Shifts Sales and Marketing Monitoring and Oversight to Plans

Executive Summary Since 2013, the Centers for Medicare & Medicaid Services (CMS) has steadily shifted direct monitoring and oversight of sales and marketing from the agency to plans. The removal…

Kim Mullins, MBAAugust 21, 2017

CMPs CMS Medicare Part C Part D

Cost of Non-Compliance

Did you know... Forty-six percent of sponsors subject to a 2016 Program Audit received a Civil Money Penalty (CMP) for violations of Medicare Parts C and D requirements found by…

Michelle Rigby, CFEJuly 17, 2017

CMPs CMS Medicare Part C Part D PBM

CMS Expands Penalties in 2017

One-Third Financial Audit Findings Will Cost You More This Year The Centers for Medicare & Medicaid Services (CMS) is now considering deficiencies found from one-third financial audits for potential enforcement…

Angela MuncyJuly 7, 2017

CMS MTM

CMS Placing More Scrutiny on MTM

Hot Topic MTM has become a popular topic with CMS not only at their Spring conference but also as a new pilot for their Program Audits. CMS is placing more…

Kelly Makay, RPh. MBAJune 27, 2017