Medicare Advantage Part D Plans

Medicare Part D - the operational challenges are real, the complexities sometimes endless. The challenges of implementing and maintaining regulatory compliance for a PDP or Medicare Advantage plan (MA-PD) providing Medicare Part D benefits are substantial for any organization, large or small. ACG provides a focused set of services for Part D plans.

Compliance Review / Mock Audit

Routinely testing a Plan Sponsor's compliance with regulation and constantly evolving CMS guidance with focus on demonstrating compliance during an audit is a best practice followed by industry leaders. ACG assists PDP and MA-PD plans plan sponsors through performing targeted or system wide mock audits and compliance reviews, including audit universe preparation, file review, policy and procedure review and delegation oversight.

Part D Operations

For Part D, the term "complexity" is an understatement ACG assists Part D sponsors to build robust end-to-end business processes and operational policies. ACG assures compliance in areas such as enrollment, grievances, marketing oversight, exceptions/coverage determinations, COB, DIR, PDE management, Part B vs. Part D determination, enrollment and financial reconciliation, delegation oversight process monitoring, and CMS complaint management.

Fraud, Waste and Abuse Program Development

Fraud, Waste and Abuse monitoring for Medicare Part D requires taking steps to minimize both internal and external risks. ACG assists PDPs and MA-PDs in program development to minimize exposure under the False Claims Act. We identify and focus audit programs for internal operations and subcontractors, identify and develop data mining methods for beneficiary, and build in procedures that assure prescriber and pharmacy fraud is eliminated. The key to success is to implement thorough FWA training programs for Part D staff.

Prescription Drug Event Data Management

Understanding PDE data errors, and their financial ramifications along with building tracking and resolution systems, requires robust business processes development. ACG can assist in analysis, PBM interface, and training and tracking system development systems. We help our clients maintain effective PDE error resolution to keep Plan operating costs in check.

Training Program Development

Staff training is critical to effective Part D operations. ACG can assist in development and tailoring of departmental specific training to meet Part D regulatory requirements. Effective grievance management requires broad and succinct training for all externally facing staff. Fraud, waste and abuse training can turn your customer service staff into the front line of defense for fraud.