Preparing for the Best Practice Review Part D Formulary and Benefit Administration Best Practices

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Preparing for the Best Practice Review Part D Formulary and Benefit Administration Best Practices. Dawn Thompson, Director Medicare Programs & Compliance Group Health Cooperative. September 5, 2012 CMS Fall Conference, Baltimore, MD. Preparing for the Best Practice Review. - PowerPoint PPT Presentation

Transcript of Preparing for the Best Practice Review Part D Formulary and Benefit Administration Best Practices

Preparing for the Best Practice ReviewPart D Formulary and

Benefit Administration Best Practices

Dawn Thompson, Director Medicare Programs & Compliance

Group Health Cooperative

September 5, 2012CMS Fall Conference, Baltimore, MD

• Integrated leadership team – strong partnerships

• Divide-and-conquer approach• Identification of process/submission owners• Single point of contact communicated

questions to CMS• Engaged executive leadership from the start

Preparing for the Best Practice Review

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• Twice daily huddles – – Take time to understand the Attachments and Universe

requests– Daily management of data and documentation

submissions– Division of labor

• Wall of work• Gap analyses• Long hours for the duration of gathering and

submitting information

Organizing the Submissions, Managing the Timelines

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• Open Communication with CMS• Understand the Attachments and submission

timelines • Consider a single point of contact for CMS• Work with CMS to set a mutually agreeable

calendar

Interacting with CMS

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• Prepare for both on-site and webinar reviews• Know your IT capabilities in advance, have IT

support on-site• Be prepared for additional upload requests• Identify one staff person to complete daily

uploads/downloads• CMS teams provided sufficient information to

understand our gaps

On-Site and Webinar Reviews

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Best Practices identified by CMS:• Open Formulary• Closed system• Electronic Health Record• In-house Customer Service and Pharmacy

Help Desk functions

Part D Formulary & Benefit Administration Best Practices

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• 80+% of our MA enrollees are in the integrated delivery system

• In-house Mail Order Pharmacy:- Mail Order Pharmacy links directly to our

electronic health record- 30% of our MA enrollees use our mail order

pharmacy

Additional Keys to Our Success

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Contact information:Dawn Thompson

thompson.d@ghc.org206-448-4619

Questions?

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