In 2019, Medicare introduced new policies for opioid prescriptions in the Medicare Part D prescription drug program to encourage pharmacies, prescribers, and Medicare drug plans to work together with the…
BluePeak AdvisorsDecember 17, 2019
In October, the National Health Care Anti-Fraud Association (NHCAA) held its annual training conference that spotlighted emerging fraud schemes. In addition to updates on the brace, genetic testing, and foot…
BluePeak AdvisorsDecember 17, 2019
Independent Review Entity (IRE) Transparency Initiative Plans are continuously looking for data to better understand their appeals outcome. The IRE transparency initiative provides plans with several more tools. During the…
BluePeak AdvisorsDecember 17, 2019
The Organizational Determination (OD) and Coverage Determination (CD) process can be a source of frustration for members, prescribers and plans. The updates to Chapter 13 and 18 highlight the expectation…
BluePeak AdvisorsDecember 17, 2019
As year-end approaches, most plans are conducting claims testing to ensure that formularies and benefits are administered correctly on January 1 and beyond. Plans and PBMs alike that have experienced…
BluePeak AdvisorsDecember 17, 2019
Financial audits are just one of the many types of Medicare Part D audits. Financial audit frequency and awareness continues to increase, and plans are realizing that they must integrate…
BluePeak AdvisorsSeptember 9, 2019
As you checked your plan data that will be displayed on Medicare Plan Finder (MPF) for accuracy during the recent second plan preview, were you happy with your Star Ratings?…
BluePeak AdvisorsSeptember 9, 2019
Prior to 2019, plan sponsors were required to make an effort determine whether an immunosuppressant should be paid under Part D or Part B based upon information they had or…
BluePeak AdvisorsSeptember 9, 2019
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
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
BluePeak is pleased to announce our most significant move yet to enhance the services we bring to our valued clients. Effective today, BluePeak Advisors has merged with Gallagher. With operations in more than 35 countries and client-service capabilities in more than 150 countries, Gallagher is a Fortune…
BluePeak AdvisorsJuly 10, 2019
Looking for more articles and insight from us? Head over to our LinkedIn page to discover more. Here are some of the recent articles posted there: Audit Tip #3-- It’s…
BluePeak AdvisorsJune 19, 2019
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
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
Q: Is it permissible for the Compliance Officer to report to General Counsel or the Legal Department? A: While some Plans and PBMs do this, it is not ideal or…
BluePeak AdvisorsJune 11, 2019
Are you drowning in developing and reviewing member material? Accuracy and timeliness are critical in all member communications. BluePeak’s consultants have experience reviewing member materials from their work at Plans…
BluePeak AdvisorsJune 11, 2019
During the CMS Spring Conference on May 1, 2019, CMS reviewed some of the revisions that are being made to Plan Finder. The redesigned Plan Finder will be used this…
BluePeak AdvisorsJune 11, 2019
The Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) have published several new proposed and final rules on various topics, ranging from prescription…
BluePeak AdvisorsJune 11, 2019
On April 30, 2019, Health and Human Services (HHS) published a final rule in which they are exercising their discretion in how they apply regulations concerning the assessment of Civil…
BluePeak AdvisorsJune 11, 2019
Bids were turned in the first Monday in June and now it is time to implement those benefits, plan designs and formularies that your organization has been hard at work…
BluePeak AdvisorsJune 11, 2019
Looking for more articles and insight from us? Head over to our LinkedIn page to discover more. Here are some of the recent articles posted there: CMS Announces Timeliness Monitoring…
BluePeak AdvisorsMarch 15, 2019
On February 8, 2019, CMS released “CMS Program Audits Frequently Asked Questions (FAQs). One of the questions addressed was: “Will sponsoring organizations always have the opportunity to submit universes up…
BluePeak AdvisorsMarch 15, 2019
CMS started issuing audit letters in March and will continue doing so through July. If you haven't already received an audit notice, what are you doing to prepare? 2019 starts…
BluePeak AdvisorsMarch 15, 2019
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
But, ready or not, CMS Program Audit Season is here! Wouldn’t it be great to know that you have done everything possible to prepare in the event you get a Program Audit notice?…
BluePeak AdvisorsMarch 15, 2019
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
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
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
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
HIPAA Violations = Potential Civil Fines and Criminal Penalties How healthy is your HIPAA Program? BluePeak’s HIPAA Program Review can help you identify and correct privacy, security and breach policy and procedure issues that might leave…
BluePeak AdvisorsDecember 7, 2018
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