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
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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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