Medicare Archives - Page 2 of 4

CMS Medicare Part D

Initial Adoption of Indication-Based Formularies as a Formulary Management Tool

In August of 2018, CMS announced that Medicare Part D Sponsors have the option to use indication-based formularies starting January 1, 2020. Prior to this change, formulary medications were considered…

BluePeak AdvisorsApril 29, 2020

Audits CMS HPMS Medicaid Medicare

Highlights of Proposed 2020 Audit Protocols

The Centers for Medicare & Medicaid Services (CMS) released an HPMS memo on August 20, 2019 providing an overview of the upcoming changes to program audits through 2021. These changes…

BluePeak AdvisorsSeptember 9, 2019

CMS FWA Medicare Part B Part C Part D

CMS Fraud Conference–Working Together to Combat Fraud

From July 16-18th over 100 investigative minds met at the annual CMS Fraud Conference in Miami, Florida to talk about current fraud schemes, emerging schemes, data analytics and how to…

BluePeak AdvisorsAugust 2, 2019

HPMS Medicare PDBM

Medicare Advantage and Prescription Drug Plan Appeals Guidance– Are You Ready?

Chapter 13 of the Medicare Managed Care Manual (MMCM) and Chapter 18 of the Prescription Drug Benefit Manual (PDBM) have been consolidated into one chapter. CMS announced the release of…

BluePeak AdvisorsJune 12, 2019

CMS Medicaid Medicare

Call Centers Beware

On May 10, 2019, CMS published a final rule on Drug Pricing Transparency. The rule, effective July 9, 2019, requires direct-to-consumer television advertisements of prescription drugs and biological products payable…

BluePeak AdvisorsJune 11, 2019

Call Letter CMS DMP Medicaid Medicare MME Part C

CMS Continues Along Its Roadmap to Address the Opioid Epidemic

Effective January 1, 2019, the Centers for Medicaid & Medicare Services (CMS) required plan sponsors to implement new opioid policies as part of the agency’s continued efforts to address the…

BluePeak AdvisorsMarch 15, 2019

CMS FDRs HPMS Medicaid Medicare Star Ratings TPMA

Potential Changes on the Horizon for 2020 and Beyond

After getting ready for all the changes a new contract year brings, Medicare Advantage (MA) Plans and Part D sponsors await the issuance of the Draft Call Letter for early…

BluePeak AdvisorsMarch 15, 2019

CMS MA Medicare Part D PDP

Drum Roll Please…The 2019 Medicare Enrollment Numbers are In.

2019 is already off to a blazing start with the implementation of Medicare Part D plans’ new opioid edits as well as 2020 formulary development. While plans are already preparing…

BluePeak AdvisorsFebruary 8, 2019

FDRs Medicare Part D Uncategorized

Ensuring Record Retention Requirements with First-tier, Downstream and Related Entities (FDR’s).

Many Medicare Plans may believe compliance with the ten-year record retention requirement is a slam-dunk. However, plans are often tripped up in audits because their first-tier and downstream entities do…

BluePeak AdvisorsFebruary 1, 2019

Medicare Part C Part D

5 Universal Strategies to Move the Needle on Star Rating Improvements: A Medication Adherence Case Study

One of the surprises in the release of plans’ Star Ratings results for the 2019 open enrollment season was that Star Ratings around Part D adherence scores, on average, slipped.…

BluePeak AdvisorsDecember 1, 2018