top of page
Search


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...
juliermason
Feb 26, 20244 min read
Â
Â
Â


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]Â takes effect for Part D sponsors to provide all Part D...
juliermason
Feb 26, 20244 min read
Â
Â
Â


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...
juliermason
Jan 24, 20244 min read
Â
Â
Â


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...
juliermason
Jan 24, 20243 min read
Â
Â
Â


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...
juliermason
Jan 24, 20242 min read
Â
Â
Â


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 &...
juliermason
Dec 27, 20234 min read
Â
Â
Â


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)...
juliermason
Dec 4, 20234 min read
Â
Â
Â


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...
juliermason
Oct 26, 20233 min read
Â
Â
Â


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...
juliermason
Oct 18, 20234 min read
Â
Â
Â


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...
juliermason
Sep 7, 20234 min read
Â
Â
Â


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...
juliermason
Aug 20, 20233 min read
Â
Â
Â


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)...
juliermason
May 30, 20234 min read
Â
Â
Â


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...
juliermason
Feb 25, 20234 min read
Â
Â
Â


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)...
juliermason
Feb 2, 20234 min read
Â
Â
Â


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...
juliermason
Nov 3, 20222 min read
Â
Â
Â


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...
juliermason
Sep 21, 20223 min read
Â
Â
Â


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...
juliermason
Aug 9, 20224 min read
Â
Â
Â


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...
juliermason
Jul 27, 20224 min read
Â
Â
Â


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...
juliermason
Jun 13, 20225 min read
Â
Â
Â


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...
juliermason
May 23, 20223 min read
Â
Â
Â
bottom of page