CMS Changes to 2019 Audit Protocol: What You Need to Know

Pharmacy teams can now expect their drug management programs to fall under considerable audit scrutiny by the Centers for Medicare and Medicaid Services regarding a new federal law that aims to prevent prescription opioid misuse and addiction.

For the first time, CMS will look at health plans’ implementation of the Comprehensive Addiction and Recovery Act throughout the program audit process.

The agency released the change as part of its 2019 audit protocols.

CMS releases changes and updates to its program audit process every year so health plans know what to expect in the event they are audited. Such probes include CMS program audits, PDE audits, one-third Financial audits, BID audits, Formulary Administration audits, Transition Monitoring Program Analysis, Coverage determination/redetermination Timeliness audits and Data Validation audits.

Medicare plans are increasingly subject to closer CMS monitoring and review. An audit is more likely now than ever before.

Be Prepared 

The team at Tier 1 Pharmacy Consulting provides support and consultation for all types of audits. We can review data to ensure accuracy with file layout requirements, interpret data to identify potential issues, craft responses, create corrective action plans and more. With experience in more than a dozen audits and a handful of mock audits, Tier 1 can find solutions and help you through the process from start to finish.

The next audit notifications will be sent between March and July.

Fewer Deliverables

The CMS changes to audit protocols include some positive news for health plans – including a reduction in audit deliverables. For example, health plans are no longer required to submit Call Logs and answers to supplemental questions during a program audit. CMS has suspended:

  • The collection of CDAG, ODAG, and SARAG Supplemental Questions at the time an audit engagement letter is drafted. Instead, CMS is encouraging plans to use the questions as a guide to determine non-compliance.
  • The collection of Call Logs, which help identify misclassification of coverage requests during the Compliance Program Effectiveness portion of an audit. The agency plans to use other ways to look at requests that are filed incorrectly, such as reviewing how well a plan oversees the call-routing process.
  • The collection of certain CPE data and documentation that can be obtained elsewhere.
  • The collection of Formulary and Benefit Administration and Special Needs Model Plan of Care enrollment verification evaluation.

CMS also has decided to make three CPE universe data fields optional: CPE FTEAM Column C, FTE Contract Effective Date; and CPE ECT Columns I and J, “Medicare Compliance Department Employee” and “Compliance Department Job Description.” The agency determined each played an insignificant role in determining non-compliance.

CMS also says it will take a broader look into the misclassification of calls as well as compliance and oversight of call routing.

The Bottom Line 

Many of the changes for 2019 will reduce the burden on health plans. Others are challenging. Plans should take steps to address the changes and plan for an audit that is likely coming – this year or down the road. We can help.

About Tier 1 

Tier 1 Pharmacy Consulting is a Denver, Colorado-based pharmacy benefit consulting firm offering customized services to healthcare plans that offer prescription drug benefits. Whether your health plan is big or small, Tier 1 offers strategic, cost-saving solutions that boost the plan’s overall value and help its members by providing high quality care.

Tier 1’s founder is a clinical pharmacist with more than a decade of experience in pharmacy benefit management. We are passionate about collaborating and developing effective strategies to improve health plan outcomes.

Tier 1 offers health plans a new perspective on how to manage their pharmacy benefit. Our team is made up of experts who strive to make effective plans even stronger and fill in any gaps due to a lack of time or resources.

Drop us a note at info@tieronepc.com. Let’s get connected.

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  229. Djinn Amoureux, explication, symptomes et Traitements chez les musulmanesLe djinn amoureux est un démon qui vit et se cache dans le corps de sa victime et la prend comme son hôte.Ce type de djinn est amoureux de sa victime (un amour maladif très possessif) et il essaie par toutes ses forces de la posséder et de contrôler sa vie. Il se raccorde au cœur pour avoir une emprise sensationnelle. Ce démon diffuse la tristesse, la colère et plusieurs sensations négatives pour affaiblir le cœur de sa victime.Ses blocages et étouffements c’est le djin en toi qui les provoquent, pour ne pas lui donner l’occasion de faire ce qu’il veut sans entré dans les détails, évite de dormir sur le dos ou sur le ventreCe type de djinn se trouve aussi bien chez les hommes que chez les femmes, qu’ils soient célibataires ou déjà mariés. Cela dit, on le rencontre cependant plus souvent chez les femmes.I/ Parmi les symptômes :La personne atteinte peut avoir ce type de symptômes :- Ne veut jamais se marier ou change de sujets-Haine inexpliquée de l’autre sexe (masculin ou féminin)-Aime la solitude-Se regarde dans le miroir- Reste longtemps dans les toilettes, la salle de bain…- Se maquille la nuit avant de dormir des fois (les femmes)- S’énerve très rapidement et changement radical de comportement d’un extrême à l’autre.- Crise et perte de conscience si le malade se retrouve avec beaucoup de monde (par exemple dans un mariage, ou au marché…)- Refus total du mariage sans raison valable.- Rêves érotiques et rêves de mariage dans une église ou ailleurs.- Haine des bonnes odeurs et répulsion pour le Musk.- Incapacité à faire correctement les adorations comme le dikr, la prière…- Avoir des bleus sur le corps.- être paralysé dans le sommeil très fréquemment- dégoût et envie de vomir, oppression sur la poitrine surtout quand lemalade voit son conjoint, il (le malade) préfère qu’il (son conjoint) soit loin de lui.II/ Les raisons principales qui causent cette maladie :- Le mauvais oeil, surtout chez les personnes qui attirent les regards des autres par leur physique.- Un sihr de divorce (pratiquement dans tous les sihrs de divorce on trouve un djinn amoureux)- Le manque de pratique dans la religion- le Sihr tassfih (sort de virginité), pour empêcher les jeunes filles d’avoir des relations sexuelles avant le mariage- Un toucher par un djinn depuis très longtemps.- lire des histoires d’amour et voir des films érotiques.- Le manque de guidée vers le droit chemin et d’adorations.- La présence d’autres personnes malades dans la famille, comme les parents ou autre, sous un même toit- La femme qui ne porte pas Al-hijab Charii (le voile légal) qui est une protection importante chez les femmes.III/ Traitements de cette maladie :L’auteur de laqt al Morjan a dit : la raison pour laquelle le djinn amoureux possède le corps et les rapports intimes. C’est pour cela que le malade doit empêcher le djinn à tout prix d’avoir des relations intimes et ne pas le laisser profiter de lui.Pour cela,- il ne faut pas dormir sans habits ou avec des habits transparents- quand on change ses habits, il faut dire bissmilah Alladi la ilaha illa howa ( Au nom d’ ALLAH, il n’y a d’autre divinité que LUI) avec l’intention de se protéger des yeux des djinns- bien faire les adhkars (invocations de protection) du matin et soir.- Éviter les péchés et faire des bonnes actions- Éviter de dormir seul et demander régulièrement à Allah qu’Il nous préserve du mal de ce djinn.

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