Compliance Archives - BluePeak Advisors

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

Compliance

Avoiding a Perfect Storm-Proactive Testing and Claims Oversight is Key

The most effective way for any plan to avoid member disruption and compliance risks for the new plan year is to establish a process to validate the accuracy of the…

BluePeak AdvisorsNovember 24, 2020

Compliance Medicare Part D

Top 3 Key Regulatory Changes for 2021

There are several noteworthy regulatory changes that require action by Medicare Advantage and Part D Plans in 2021. 1. Provider-Facing Electronic Real-Time Benefit Tool (RTBT) CMS issued a final rule…

BluePeak AdvisorsSeptember 30, 2020

CMS Compliance MA Part C Part D

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

Background On September 14, 2020 CMS released The Advance Notice of Methodological Changes for Calendar Year (CY) 2022 for Medicare Advantage (MA) Capitation Rates and Part C and Part D…

BluePeak AdvisorsSeptember 21, 2020

Compliance IRE MA MA-PD Part D PBM

Using Interim Staffing to bring Appeals and Grievances Timeliness into Compliance–A Case Study

Sometimes, life happens. Turnover, volume increases, changing guidance, system changes or audit issues that require remediation all can create situations where a Plan or PBM needs expert resources fast. And…

BluePeak AdvisorsMarch 15, 2019

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

Compliance Section 1557 Section 504 Section 508

What You Need to Know About Sections 504, 508 and 1557

You likely saw that CMS recently released a FAQ document on Section 504 and Section 1557. This FAQ document provides clarity on requirements that several organizations have been questioning since…

BluePeak AdvisorsJuly 3, 2017