Role of the Payer in Managing Opioid Use Disorder (OUD)

Role of the Payer in Managing Opioid Use Disorder (OUD) By Julie Mason, Principal Polypharmacy is common among older adults, according to a New York Times article published on December 16, 2019. Individuals aged 65–69 years take an average of 15 prescriptions a year,...

Compliance Spotlight to Shine Brightly on FMOs

Compliance Spotlight to Shine Brightly on FMOs By Julie Mason, Principal After years of intense oversight of Medicare Advantage (MA) and Part D plans (plans) by CMS, those same plans have, in turn, intensified their oversight of contracted entities, including FMOs and...

Medicare Advantage: Not Too Soon for Spring Training

Medicare Advantage: Not Too Soon For Spring Training By Julie Mason, Principal In the midst of baseball’s post season, I can’t help but compare CMS program audits to America’s favorite pastime.  Medicare Advantage (MA) and Prescription Drug Plans that weren’t audited...

FDR Compliance/FWA Training: CMS Contradicts Itself

FDR Compliance/FWA Training: CMS Contradicts Itself By Julie Mason, Principal As a best practice to document compliance with the latest Centers for Medicare and Medicaid (CMS) compliance program requirements, some Medicare Advantage organizations (MAOs) may make use...

The first 2018 CMS audit notices have been sent…

The first 2018 CMS audit notices have been sent…By Julie Mason If you are one of the “lucky” recipients, buckle your seat belt for the wild ride ahead.  It takes stamina, acute attention to detail, speed, and a mountain of resources to navigate these program audits. ...