Topic: Part D

Reflections on the Basics of Delegation Oversight

Regan Pennypacker

Imagine entering University and enrolling into Advanced French Language and Literature, a 300-level class, with no previous knowledge or study of the French language. As your professor welcomes you into class with bonjour, bienvenue, ça va, you have no idea how to reply. Now imagine sticking with that course for the full semester, trying to understand complex language and reading concepts without the foundation or basics. It would be quite an overwhelming few months for anyone.

Read more

Leave a comment | Share | |

Preparing For The 2017 Call Center Monitoring

Angela Fox

On November 16, 2016, the Medicare Drug Benefit and C & D Data Group of the Centers for Medicare & Medicaid Services (CMS) issued the “2017 Part C and Part D Call Center Monitoring and Guidance for Timeliness and Accuracy and Accessibility Studies”.

Read more

Leave a comment | Share | |

The Top Three Benefits of an Operational Assessment

Julie Billman

Times are busy. In Operations departments, they are always busy. We are all doing more with less, which makes things hectic, and everyone is playing catch-up. In the midst of it all, operational assessments, process and efficiency enhancements, and internal compliance reviews are always on the list but are often moved to a future time when things are a little slower – a time that is often just out of reach.

Read more

Leave a comment | Share | |

Preparing for the 2018 Medicare Advantage and Part D Application Season

Regan Pennypacker

On October 31, 2016, the Centers for Medicare & Medicaid Services (CMS) posted the 30-day releases of the 2018 Medicare Advantage and Part D new application and service area expansion instructions for public comment.

Read more

Leave a comment | Share | |

PBM-Supported Part D Measures Impact Quality Bonus Payment Revenues

Lisa Erwin

Regulatory time frames around coverage determinations and appeals have existed since the inception of the Part D benefit. Timely access to medications has been a hallmark of the “member protective” stance the Centers for Medicare & Medicaid Services (CMS) has taken since Day 1. So how is it, even 10+ years into the delivery of the program, compliance with these time frames continues to be the bane of health plan Compliance and Star Ratings teams?

Read more

Leave a comment | Share | |

CMS Provides Reminders on Key Dates in the MA-PD Application Process

Olga Walther

Open Enrollment for the Affordable Care Act Marketplaces and the Annual Election Period for Medicare is underway. But this month also marks the start of required Centers for Medicare & Medicaid Services (CMS)-facing activities necessary for the application process.

Read more

Leave a comment | Share | |

CMS Releases Long-Awaited Civil Money Penalty Calculation Methodology

Olga Walther

On September 13, 2016, the Centers for Medicare & Medicaid Services (CMS) quietly released its long-awaited proposed methodology on the calculation of Civil Money Penalties (CMPs).  The memo describes the calculation method of CMPs for Medicare Advantage Organizations (MAOs), Prescription Drug Plans (PDPs), Cost Plans, and Programs of All-Inclusive Care for the Elderly (PACE) plans in 2017. While CMS is not mandated to release this methodology, it did so in response to industry concern over transparency of CMP calculation and to provide more clarity to compliance operations. Comments on the proposed methodology are due to CMS by 5:00 p.m. ET on October 13, 2016.

Read more

Leave a comment | Share | |