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
- 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
- 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...
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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...
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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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juliermason
- May 23, 2022
- 4 min
Impact of CMS Changes to Negotiated Price Definition in the Final Rule
By Yvonne Tso, Pharm. D., MBA On May 9, 2022, the Centers for Medicare & Medicaid Services (CMS) issued final rules for Policy and...
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juliermason
- Oct 19, 2021
- 4 min
Changes in the CMS Readiness Checklist for 2022
by Yvonne Tso, PharmD, MBA Annually, the Centers for Medicare & Medicaid Services (CMS) distributes a Readiness Checklist to Medicare...
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juliermason
- Jun 16, 2021
- 3 min
Leveraging Medicare audits to improve processes and the bottom line
by Yvonne Tso, Pharm D., MBA The Centers for Medicare & Medicaid Services (CMS) announced that engagement letters for routine audits...
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juliermason
- May 17, 2021
- 6 min
The CMS 2020 Audit and Enforcement Report is Out—What the Results Might Mean for 2021
The much-anticipated 2020 CMS Program Audit and Enforcement Report was released on Friday, May 14. CMS readily admits in the report that...
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