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

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.

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

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  1. Preparing for the Best Practice ReviewPart D Formulary and Benefit Administration Best Practices Dawn Thompson, Director Medicare Programs & Compliance Group Health Cooperative September 5, 2012 CMS Fall Conference, Baltimore, MD

  2. Preparing for the Best Practice Review • 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 2

  3. Organizing the Submissions, Managing the Timelines • 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 3

  4. Interacting with CMS • 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 4

  5. On-Site and Webinar Reviews • 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 5

  6. Part D Formulary & Benefit Administration Best Practices Best Practices identified by CMS: • Open Formulary • Closed system • Electronic Health Record • In-house Customer Service and Pharmacy Help Desk functions 6

  7. Additional Keys to Our Success • 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 7

  8. Questions? Contact information: Dawn Thompson thompson.d@ghc.org 206-448-4619 8

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