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...

Don’t Miss the 2021 NOIA Deadline

Don’t Miss The 2021 NOIA DEADLINE By Janet Eisenberg, Vice President The Contract Year 2021 application process with CMS requires detailed planning and enough lead time to efficiently meet application deadlines. With over 150 combined years of experience 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...

2020 CMS Program Audit Overview

2020 CMS Program Audit Overview  By Yvonne Tso, Vice President First, some good news: as of August 25, 2019, if a sponsoring organization (“Sponsor”) has not been notified by the Centers for Medicare & Medicaid Services (CMS) of an upcoming audit, it is safe to...