Medicare Archives - BluePeak Advisors

Audits Medicare Part D Spring 2024 Utilization Management

What Risk Does the new TERM Table Really Pose?

Have you heard about the new table initially required in the CMS Utilization Management (UM)-Focused audits? Also, known as “Table 7”, Plans need to ensure an ability to report accurate…

BluePeak AdvisorsMarch 29, 2024

CMPs CMS IRA Medicare NABA NONC Part D Spring 2024

The Importance of Medicare Marketing Material Development and Review, New changes coming and 2024 finding examples

Member materials are an important part of the Medicare member experience with a plan. Each year as Plan Sponsors finalize their product bid filing, CMS releases the upcoming plan year…

BluePeak AdvisorsMarch 29, 2024

February 2023 Medicare Part A Part B Part C Part D

BluePeak provides fresh insight into the CMS Proposed Rule for 2024

On December 27, 2022, the Centers for Medicare & Medicaid Services (CMS) published proposed rule (CMS_FRDOC_0001-3474) in the Federal Register. If finalized, this proposed rule would revise the Medicare Advantage…

BluePeak AdvisorsFebruary 3, 2023

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

Fall 2022 Medicare

CY 2022 Part C and Part D Reporting Technical Specifications – Do You Know What Has Changed?

In June, CMS issued updated technical specifications for CY 2022 Medicare Part C and Part D reporting. BluePeak has summarized the key changes in the technical specifications below. BluePeak compared…

BluePeak AdvisorsAugust 25, 2022

Audits CMS Medicare Part D

Will Your Grievance Resolution Letters Stand Up in an Audit?

Across the Medicare Advantage and Part D industry, Plans are nervous about how their grievance resolution letters will present and stand the test in a CMS Program Audit. BluePeak Advisors…

BluePeak AdvisorsFebruary 18, 2022

CMS Medicare Part D

Two Rules With Potential Part D Rebate Access Impact

Two rules have the potential to impact how Part D price concessions and pharmaceutical rebates are managed and how these changes, when implemented, will subsequently impact a Part D sponsor’s…

BluePeak AdvisorsFebruary 9, 2022

Audits CMS Medicaid Medicare

Program Audit Consistency Teams (PACTs)

In the ‘2022 Program Audit Process Overview’1 document, the Centers for Medicare & Medicaid Services (CMS) shared that they will send engagement letters to initiate routine audits beginning February 2022 through…

BluePeak AdvisorsFebruary 9, 2022

Claims Medicare

Why Medical Claims Audits?

In view of ever rising benefit costs, employers and Medicare Advantage plans should consider a medical claims audit as part of an overall benefits and cost-containment strategy. Medical claims audits…

BluePeak AdvisorsFebruary 9, 2022

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