Proposed Methodological Changes for CY 2025
by Yvonne Tso, PharmD, MBA Every year, the Centers for Medicare & Medicaid Services (CMS) informs stakeholders of the methodological...
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juliermason
- Feb 26
- 4 min
New Requirement to Improve Access and Affordability of Part D Drugs in 2025 (MPPP)
by Yvonne Tso, PharmD, MBA Beginning in CY 2025, a statutory requirement[1] takes effect for Part D sponsors to provide all Part D...
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juliermason
- Jan 24
- 4 min
Part D Fraud, Waste and Abuse Scams
by Yvonne Tso, Senior VP, PharmD, MBA It has been said many times and in many ways – fraud, waste and abuse (FWA) prevention, detection...
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juliermason
- Jan 24
- 3 min
Medicare Part D Re-Design
by Yvonne Tso, Senior VP, PharmD, MBA The prescription drug program, or Part D, as we know it will have a different look and feel in...
106 views0 comments
juliermason
- Jan 24
- 2 min
Upcoming CMS Prior Auth Audits—Are You Ready?
by Julie Mason, President As you are probably aware, CMS has announced that it will be conducting audits of the prior authorization...
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juliermason
- Dec 27, 2023
- 4 min
Proposed MA/Part D Changes for 2025 — Part II
by Yvonne Tso, PharmD, MBA This article is the second in a series that highlights proposed changes for 2025 by the Centers for Medicare &...
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juliermason
- Dec 4, 2023
- 4 min
Proposed MA/Part D Changes for 2025 — Part I
By Yvonne Tso, PharmD, MBA On November 6, 2023, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule (CMS-4205-P)...
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juliermason
- Oct 26, 2023
- 3 min
New Medicare Advantage UM audits are coming...are you ready?
By Julie Mason, Integritas President CMS notified MA plans this week that it will be conducting audits of the new prior authorization and...
339 views0 comments
juliermason
- Oct 18, 2023
- 4 min
MA Plans, Are You Ready for 2024?
by Yvonne Tso, PharmD, MBA Every year in October, the Centers for Medicare & Medicaid Services (CMS) publishes a readiness checklist for...
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juliermason
- Sep 7, 2023
- 4 min
Fraud Surveillance in Annual CPE Audits
by Yvonne Tso, PharmD, MBA In August 2023, CMS’ Fraud Investigations Group released 16 fraud case announcements via HPMS to alert all...
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juliermason
- Aug 20, 2023
- 3 min
Getting Ready for 2024 Risk Adjustment Changes
by Yvonne Tso, PharmD, MBA Medicare Advantage Organizations (MAOs) are about a month away[1] from executing their contracts with the...
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juliermason
- May 30, 2023
- 4 min
Implementing IRA provisions Beyond 2023 and Managing Rising Financial Liability
by Yvonne Tso, PharmD, MBA Since passage of the Inflation Reduction Act (IRA) in August 2022, the Centers for Medicare & Medicaid (CMS)...
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juliermason
- Feb 25, 2023
- 4 min
2024 Draft Advance Notice – Make your opinions known!
by Yvonne Tso, PharmD, MBA On February 1, 2023, the Centers for Medicare & Medicaid Services (CMS) published the draft Advance Notice of...
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juliermason
- Feb 2, 2023
- 4 min
Can you pass a Risk Adjustment Data Validation audit?
by Yvonne Tso, PharmD, MBA On January 30, 2023, the Centers for Medicare & Medicaid Services (CMS) published the Final Rule (CMS 4185-F)...
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juliermason
- Nov 3, 2022
- 2 min
CMS Program Audits: Not for the Faint of Heart
CMS program audits aren't for the faint of heart; they are stressful, time-consuming, labor-intensive, and can impact the future of your...
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juliermason
- Sep 21, 2022
- 3 min
Congress seeks to improve MA prior auth process
by Yvonne Tso, PharmD, MBA The House of Representatives is proposing legislation (H.R. 3173) to streamline prior authorization...
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juliermason
- Aug 9, 2022
- 4 min
Lots of New ODAG/CDAG Guidance and Clarity
by Yvonne Tso, PharmD, MBA On August 3, 2022, the Centers for Medicare & Medicaid Services (CMS) released an updated version of the Parts...
264 views0 comments
juliermason
- Jul 27, 2022
- 4 min
CMS Wants to Know: Are You Overcharging Members for Drugs?
By Yvonne Tso, PharmD, MBA All Medicare Advantage and Prescription Drug Plans (collectively, Sponsors) submit prescription drug event...
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juliermason
- Jun 13, 2022
- 5 min
All the new in the CMS ’22 ODAG Protocol
by Yvonne Tso, Senior Vice President of Pharmacy, Pharm.D., MBA The Centers for Medicare & Medicaid Services (CMS) launched a new cycle...
335 views0 comments
juliermason
- May 23, 2022
- 3 min
Using CMS Data for Identifying Potential FWA
by Yvonne Tso, Pharm. D., MBA On April 15, 2022, the Centers for Medicare & Medicaid Services (CMS) released potential fraud, waste and...
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