The Part D Shell Game
Top of mind when we are talking about Medicare compliance should be that the ultimate customer is the … Read more
View ArticleHow to Secure a PBM Contract That Meets Your Goals
At the beginning, it all sounds great…the PowerPoint presentation was informative, and the staff who came to present … Read more
View ArticleCare Management Interdependencies
It’s impossible to achieve reasonable and prudent member care management in a vacuum. The three-legged stool supporting care … Read more
View ArticleRejected Claims Review–You Gotta Do It!
The question arises from almost every client, “Why do we have to do daily rejected claims review?” The … Read more
View ArticleOpioid Abuse: A Growing Compliance Risk for Medicare Advantage Plans
Opioid overutilization and the corresponding public health crisis are ubiquitous in the daily news. In September 2017, the … Read more
View ArticleChecklist: 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 … Read more
View ArticleSupplemental Benefits: New Rules and New Opportunity
Two recent Centers for Medicare & Medicaid Services (CMS) Health Plan Management System (HPMS) memos clarified supplemental benefit … Read more
View ArticleMedication Reconciliation: A Primer for Health Plans
What is the definition of medication reconciliation? The Joint Commission defines medication reconciliation as the process of comparing … Read more
View ArticleWhat Health Plan Sponsors Need to Know about the 340B Program
The 340B discounts are not taken from U.S. tax dollars. The 340B program is a federal drug discount program, requiring manufacturers to offer statutorily determined discounts, which often represent a...
View ArticleCMS Proposed Rule Addresses Rx Pricing in Medicare Advantage and Part D
The Centers for Medicare & Medicaid Services (CMS) released detailed and specific requirements on November 20, 2018, in the “Part D Drug Management Program Policy Guidance.” The release includes...
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