MA Archives - BluePeak Advisors

FDR MA Part D September 2023

Changes to CMS Requirements for Translation and Alternate Formats

To ensure effective communication and meaningful access, Medicare Advantage (MA) and Prescription Drug Plans (PDPs) have been obligated to follow various, occasionally interconnected directives for translating member documents into different…

BluePeak AdvisorsSeptember 7, 2023

Consultant Corner February 2023 MA

Consultant Corner: Does Requiring Prior Authorization from Contracted Providers Benefit or Burden Medicare Advantage (MA) plans?

Lisa Barker is BluePeak Part C Lead Providers, Industry Groups and the Office of Inspector General (OIG) have been very vocal about concerns for prior authorization requirements creating barriers that…

Lisa BarkerFebruary 3, 2023

MA November 2022

Effective Strategies in Claims Quality Auditing

In light of ever rising benefit costs, employers and Medicare Advantage (MA) plans should consider regular claims quality auditing as part of an overall benefits and cost-containment strategy. Claims audits…

BluePeak AdvisorsDecember 1, 2022

MA MCMG Medicare November 2022

Risks in Misclassifying First Tier, Downstream, and Related Entities (FDRs)

There are a number of criteria outlining the oversight of First Tier, Downstream and Related Entities for Medicare Advantage Organizations. Chapters 21 / 9 and 11 of the Medicare Managed…

BluePeak AdvisorsDecember 1, 2022

MA Part C Part D Star Ratings

Early Release of Medicare Advantage and Part D Advance Notice: Part C & D Star Rating Changes

CMS published Part I of the Advance Notice of Methodological Changes for Calendar Year (CY) 2022 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies…

BluePeak AdvisorsDecember 18, 2020

Enrollment ESRD MA

Compliance and Operational Considerations for Medicare Advantage Plans with Increasing Enrollment of End Stage Renal Disease (ESRD) Beneficiaries

For the first time, starting in 2021, the 21st Century Cures Act allows beneficiaries diagnosed with ESRD to enroll in MA plans. These beneficiaries have previously been required to stay on Medicare Fee-for-Service…

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

COVID19 MA SEPs Star Ratings SUPD

Operational Impact of the Contract Year 2021 Final Rule

Operational Impact of the Contract Year 2021 Final Rule On June 2, 2020 CMS released the Contract Year 2021 and 2022 Policy and Technical Changes to the Medicare Advantage Program,…

BluePeak AdvisorsJune 17, 2020

CMS MA Uncategorized

CMS Releases Final Rule on Interoperability and Patient Access

On March 9, 2020, the Centers for Medicare & Medicaid Services (CMS) released the final rule (CMS-9115-F) regarding Interoperability and Patient Access. While CMS issued a fact sheet regarding this rule, this rule…

BluePeak AdvisorsMarch 18, 2020

DMP MA PACE Part C Part D RTBT

10 Things Plans Need to Know about the 2021 and 2022 Policy and Technical Changes Proposed Rule

On February 5, 2020, the Centers for Medicare & Medicaid Services (CMS) announced it will not be publishing a Call Letter for 2021. Rather, CMS is codifying guidance typically published…

BluePeak AdvisorsFebruary 25, 2020