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 264 min read
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 244 min read
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 243 min read
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...
107 views0 comments
juliermason
Jan 242 min read
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, 20234 min read
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, 20234 min read
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, 20233 min read
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, 20234 min read
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, 20234 min read
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, 20233 min read
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, 20234 min read
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, 20234 min read
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, 20234 min read
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, 20222 min read
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, 20223 min read
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, 20224 min read
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...
286 views0 comments
juliermason
Jul 27, 20224 min read
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...
56 views0 comments
juliermason
Jun 13, 20225 min read
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...
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juliermason
May 23, 20223 min read
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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