Recent 1/3 Financial Audits have focused on the accuracy of billing of medications while a member is in a skilled nursing facility (SNF). Most drugs administered during an acute stay in…
BluePeak AdvisorsMarch 12, 2021
Industry News
New COVID-19 Related Audit Considerations In addition to all of the other usual audit concerns, Plan Sponsors should also be prepared for CMS to scrutinize all things COVID-19 related. As…
BluePeak AdvisorsMarch 12, 2021
More Rigorous CMS Oversight and Audit Activity Ahead Audit notices are already hitting inboxes as CMS is kicking off a longer than usual Program Audit season this year (March through…
BluePeak AdvisorsMarch 12, 2021
Common Findings by Program Area In addition to ensuring compliance with COVID-19-driven changes, it is equally important to keep in mind lessons learned from prior audits when preparing for the…
BluePeak AdvisorsMarch 7, 2021
While CMS has been conducting audits for many years via webinar, the new reality is that many of the Plans being audited this season may have workforce at home. Following…
BluePeak AdvisorsMarch 5, 2021
Contract Year 2022 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicaid Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the…
BluePeak AdvisorsMarch 5, 2021
President Biden hit the ground running, signing a batch of Executive Orders just hours after he was sworn in as the 46th President of the United States. A couple of…
BluePeak AdvisorsJanuary 22, 2021
COVID-19 is having a dramatic impact on our lives, businesses and health care system. We understand that information and circumstances are changing rapidly and that many of your team members are…
BluePeak AdvisorsJanuary 19, 2021
CMS announced they will be performing a 2021 transition of care audit using the Transition Requirements Analysis (TR) that was piloted back in 2019. Although the 2019 TRA did not…
Amy DenihanJanuary 8, 2021
While compliance is a year-round expectation of the Centers for Medicare and Medicaid Services (CMS), plans are under even greater scrutiny by CMS and members alike at the beginning of…
BluePeak AdvisorsDecember 18, 2020
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
CMS released several interim and final rules in the past month. As the new year starts and there is a change in administration, the pace of new guidance releases is…
BluePeak AdvisorsDecember 18, 2020
Participation is expected to be strong in the Part D Senior Savings Model launch on 1/1/21 with 1,750 plans across 88 sponsors and 3 manufacturers participating in the program. Participating…
BluePeak AdvisorsDecember 18, 2020
Unapproved Drugs Initiative Terminated On November 20, 2020 The Department of Health and Human Services terminated the Unapproved Drugs Initiative. The 2006 Unapproved Drug Initiative requires manufacturers to submit drugs…
BluePeak AdvisorsDecember 18, 2020
On November 2, 2020, CMS released the results of the CY2020 Monitoring of Posted Comprehensive Formularies or their Posted versus Approved (PvA) analysis. For the CY2020 analysis, CMS announced that…
BluePeak AdvisorsNovember 24, 2020
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
As the date for compliance with the Interoperability Rule draws closer, BluePeak answers all of your questions, to help you stay in the know. 1 Question: I read the required…
BluePeak AdvisorsNovember 24, 2020
The last quarter of 2020 will likely be the most significant and the most challenging testing season plans have experienced. Unfortunately, there may be a perfect storm brewing that is…
BluePeak AdvisorsNovember 3, 2020
Reprinted with AIS Health permission from the October 1, 2020, issue of RADAR on Medicare Advantage CMS’s latest overview of program audits showed continued improvement among Medicare Advantage and Part…
BluePeak AdvisorsOctober 9, 2020
The most effective way for any Plan to mitigate any compliance risks for the new plan year is to strategize a process to validate the accuracy of the formulary and…
BluePeak AdvisorsSeptember 30, 2020
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
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
Plans may have noticed that CMS has been busy this season making changes to certain Enrollment policies, materials, and software releases to keep up with the changing environment of today…
BluePeak AdvisorsSeptember 30, 2020
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
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
Background On April 6, 2020, the Centers for Medicare & Medicaid Services (CMS) issued Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency (CMS-1744-IFC) as an interim…
BluePeak AdvisorsJune 13, 2020
On May 23, 2019, the Centers for Medicare & Medicaid Services (CMS) published a final rule (CMS-4180-F) which adopted new processing timeframe requirements for preservice organization determinations and plan reconsiderations…
BluePeak AdvisorsJune 13, 2020
Over the course past year, CMS issued several different proposed and final rules that address making certain data available in a real-time or near real-time manner. The table below summarizes…
BluePeak AdvisorsJune 13, 2020
CMS guidance requires Medicare Advantage Plans to have an independent audit of their compliance program’s effectiveness each year. Given competing priorities, it may be tempting to conduct a limited or…
BluePeak AdvisorsJune 13, 2020
8 Tips to Ensure Your Plan is Ready After months of hard work and planning, everyone sighed with relief when bids and formularies were submitted earlier this month. But, as…
BluePeak AdvisorsJune 13, 2020
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