Checklist: Is Your Part D Program Running Smoothly?

“There’s no harm in hoping for the best as long as you’re prepared for the worst.”—Stephen King

You’ve spent the whole year progressing from transition benefits, annual reports, potentially a service area expansion, formulary review and development and submission, bid development and submission, CMS program audits, internal audits, Star ratings, Readiness assessments etc. etc. And now you have to start all over again. But before you can start the cycle you have a few boxes to check to make sure January goes smoothly. For Part D programs you should have the following checks:

  • Benefit testing provided by the PBM showed few to no defects and those identified issues have been resolved-you’ve checked transition tests over and over and over
  • Contingency staffing plans for potential increases in member service calls from December 31 through January 15 are in place
  • You have assurances from your PBM that they are prepared to produce CMS required universes for audits, formulary administration analysis, transition analysis and the new coverage determination analysis
  • You have updated your delegation oversight/monitoring plan to reflect new regulations, new support documents and new deadlines or timeframes
  • You have data to support programs to move the needle in 2018 for the medication measures and Part D domain measures
  • You are ready to review all rejected claims daily

Getting out of the gate without compliance issues on January 1 is the goal—and if there are a few bumps in the road, plan to address them early and institute quick changes to ensure you are back on track. Let the GHG team assist you with a mock audit to assure that you are ready, willing and able to undergo a CMS program audit in 2018!

We wish you a smooth and uneventful beginning to 2018.



Our Part D services are designed with your staff in mind, ensuring that with a mix of counsel and DIY tools your staff will have access to actionable information – faster. Don’t chase data points.  Spend your time on the things that will impact your audit results when a CMS audit comes – and it always does. Contact us today to get started >>

With GHG’s in-depth delegation oversight assessments, our experts can help your organization learn where and how to verify potential issues and identify risk – empowering your teams to ask the tough questions. Let us help you get the answers you need >>

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Debra Devereaux
Debra Devereaux

Deb Devereaux is Senior Vice President of Pharmacy and Clinical Solutions at Gorman Health Group (GHG). In this role, she is responsible for leading a team of pharmacists and business analyst consultants with broad health plan, Centers for Medicare & Medicaid Services (CMS) and Pharmacy Benefit Manager (PBM) experience. Deb brings GHG clients more than eight years of Medicare Part D operations expertise. Read more

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