Ready or not-the 2018 Audit Season is Upon Us… Highlights of CMS Proposed Changes in Draft 2019 Call Letter Appeals and IRE Data Issues Can Impact Audit Scores, Star Ratings and CMPs BluePeak Service Spotlight: Mock Audits with UMS and Call Log Reviews ICYMI - BluePeak's Articles posted recently on LinkedIn

Ready or not-the 2018 Audit Season is Upon Us… As Plans Continue to Struggle with the Same Common Conditions, CMS Makes Few Changes from the 2017 to 2018 Audit Protocols   As the Centers for Medicare and Medicaid Services (CMS) begins sending program audit engagement letters this month, plans may have noticed changes from the 2017 to 2018 protocols are minimal. As CMS enters the last year of this audit cycle (2015-2018), plans continue to struggle with the same common conditions these protocols were designed to identify. Click to read all the changes from the 2017 to 2018 CMS program audit protocols.

Highlights of CMS-Proposed Changes in Draft 2019 Call Letter The Centers for Medicare and Medicaid Services (CMS) proposes changes to Star Ratings, validation audits, annual Compliance Program Effectiveness (CPE) audits, Part D opioid overutilization policy, and more in the draft 2019 Call Letter that was released February 1. Click to review BluePeak's high-level summary of proposed changes and clarifications

Appeals and IRE Data Issues Can Impact Audit Scores, Star Ratings and CMPs   Whether deficiencies are discovered as part of a CMS program audit or a Timeliness Monitoring Project (TMP) review, issues with appeals and Independent Review (IRE) data can impact a plan’s Star Ratings and result in CMS enforcement actions, including Civil Money Penalties (CMPs). Click read the full article

BluePeak Service Spotlight: Mock Audits with UMS and Call Log Reviews BluePeak has conducted over 150 CMS mock audits and onsite support projects for clients undergoing actual CMS program audits. We also offer mock audit breakouts, such as our Universe Monitoring Service and Independent Call Log Review. Contact us today for a free consultation.

ICYMI - BluePeak's Articles posted recently on LinkedIn * CMS Account Managers May Contact Plans to Assess New Medicare Card Project Readiness * PDE Self-Audits Cost At Least One Plan Over $1 Million in Claims Reversals * CMS to Conduct Provider Network Adequacy Audits for Medicare Advantage Every 3 Years * Medicare-Medicaid Plan Audits Fully Operational in 2018 With Some Changes to 2017 Protocols * CMS Conducting Appeals Timeliness Monitoring, Again

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join us at one of these upcoming events HEA 3rd Annual Optimizing Appeals & Grievances and Improving ODAG & CDAG Outcomes Babette Edgar,  Principal  March 21-23, 2018 : Baltimore, MD AMCP Managed Care & Specialty Pharmacy Annual Meeting Babette Edgar,  Principal  Michelle Rigby , Director, Client Services Kelly Makay , Sr. Consultant April 23-26, 2018 : Boston, MD We are looking for talented, dynamic, and highly-motivated people who are passionate about helping clients succeed. Sound like you? Sr. Consultant, Part D Pharmacist Sr. Consultant, Operations and Compliance Sr. Consultant, SNP-MoC (PT) Sr. Consultant, Part D Claims (PT) Sr. Consultant, Part C and CPE (PT) Head to our careers page to learn more http://bluepeakadvisors.com/careers/

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