Something Old, Something New: Medicare Audits 2017 and Beyond

ACPE UAN #:  0233-0000-16-042-H04-P 

Release Date: December 20, 2019

Expiration Date:  October 4, 2019

Activity Type:    Knowledge-based

Contact Hours:  1.5

Activity Fee:  Member:  $15        Non-Member: $30

Target Audience: Pharmacists who practice in managed care settings.

Activity Overview

Medicare may be the ultimate moving target for managed care organizations, a situation that can make for challenging operational and compliance audits. The Centers for Medicare and Medicaid Services (CMS) release frequent New Health Plan Management System (HPMS) memos that detail new actions pharmacists must take in the ever-changing program. For instance, in 2016, CMS changed the timeframes for releasing annual audit protocols and added a new pilot audit protocol for medication therapy management (MTM). Meanwhile, health plans continue to struggle with some long-standing Medicare operational issues, despite being knowledgeable about the pitfalls and how to remediate them. Understanding how to proactively prevent common audit findings is instrumental to ensuring a successful audit and providing the care and benefits that are required by Medicare.

In this session, pharmacists will learn everything they need to know to be prepared for Medicare operational and compliance audit changes in 2017 and beyond. 

Learning Objectives:  

At the completion of this activity, participants should be able to:

  1. Outline changes to Medicare audit protocols that will occur in 2017.
  2. Discuss the methodologies for the new medication therapy management (MTM) pilot audits and experiences with the pilot protocols from 2016.
  3. Explain how pharmacists are using the 2016 CMS Job Aids to enhance compliance within managed care organization pharmacy departments.
  4. Identify ways in which pharmacists can proactively find, fix and prevent reoccurrences with Medicare pharmacy issues affecting audit protocols.

Schedule of Educational Activity

This activity consists of an audio recording, pre-test assessment questions (not required to pass or continue), post-test questions (required to pass with a score of 70% or higher) and a specific activity evaluation. 

CPE Requirements:   

Participants should claim continuing pharmacy education (CPE) credit for this home study activity only if they have not claimed credit for the live activity presented at AMCP Nexus 2016. 

CPE credit will be processed through the AMCP Learn portal and reported directly to CPE Monitor.  Please allow 72 hours for processing and posting in your NABP account.

To receive credit for an online activity you must:

  • Review the full content of the activity.
  • Successfully complete the post-test (required to pass with a score of 70% or higher, it may be taken a maximum of three times).
  • Complete a specific activity evaluation.

System Technical Requirements/Viewing Requirements: System Requirements Courses and learning activities are delivered via your Web browser and Acrobat PDF. For all activities you should have a basic comfort level using a computer and navigating web sites.  View the minimum technical and system requirements for continuing education online learning activities.

The Academy of Managed Care Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

As an accredited provider, AMCP strictly adheres to the ACPE Standards for Commercial Support and other relevant guidelines and standards to ensure the independence of continuing pharmacy education (CPE) activities.  It is AMCP’s intent that all CPE activities be independent, objective, balanced, evidence-based and free of any commercial bias.

James R. Hopsicker, RPh, MBA
Vice President, Pharmacy Programs MVP Health Care
Schenectady, New York

Credit Information

Activity Number Credit Amount Accreditation Period
ACPE UAN #0233-0000-16-042-H04-P 1.5 Contact Hours October 04, 2016 - October 04, 2019