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Company Info

Medicare and Part D Compliance Specialists LLC (MPDCS) is an independent consulting firm that performs Independent Audit Validations.  Founded and operated by two Medicare Part D pharmacists, MPDCS is committed to providing clients an optimal Medicare Part C and/or D consulting experience by building teams that best suit a client’s needs.  MPDCS’ focus is dedicated to supporting a compliant and seamless administration of the Medicare benefit.  Our practical and compliance focused approach provides productive solutions that ensure you are meeting not only CMS’ requirements, but also their expectations.

Services

MPDCS provides both Medicare Part C and D services. As pharmacists specializing in Medicare Part D for over 10 years, we team with the best partners in the industry on the Part C side. Whatever the need, MPDCS can execute.
Medicare Part D is a complex benefit to administer. MPDCS can help you navigate efficiently through maximizing your operational practices, understanding both health plan and PBM perspectives and challenges. A simplistic, one size fits all administration of the benefit usually lands health plans in the realm of CMS scrutiny. Plans and PBMs not only have to understand the guidance but also CMS’ intent; the gray areas open to a level of interpretation tend to be particular areas of concern. MPDCS’s seasoned pharmacy staff have both PBM and health plan experience that can assist you in moving into the stream of compliance and continued success.

Mock Audits and CMS Audit Support

Let MPDCS prepare you for receiving that always-impending audit letter from CMS. Mock audits not only help prepare for the inevitable, but also provide significant benefit in identifying potential unknown issues. Even if it is weeks before your CMS audit, knowing your weak spots provides the opportunity to remediate issues before the audit occurs.

Not only can we help you prepare for a CMS audit, MPDCS can help you through the audit. Simply stated, CMS has tired of lackluster data preparation. Helping you prepare for the audit, assist with responses to CMS and post remediation work is our specialty. Whether you did not have a process and policy or where the policy and process may have been deficient, a new or updated flow and approach can be devised that works for you, your staff and your systems.

Formulary and Benefit Testing Assessment

Did you have time to work with your PBM to review and assess your formulary and benefit configuration?  The process usually starts in late summer or early fall but far too often it comes down to the wire in December.  MPDCS can help work with the health plan and PBM to ensure that adequate testing and analyses are performed that meet CMS’ expectations in preparation of the upcoming contract year.

Mock Audits and CMS Audit Support

CDAG has become a focus for CMS and is one of the highest risk areas.  Operational issues complicate efficient operations and appropriate effectuation.  Oversight of processes is key in ensuring effective and compliant processes are in place.  MPDCS can assist you in developing internal monitoring and delegation oversight processes and programs in addition to preparing you in a mock audit.   Our clinicians can support you in the review of your clinical decision making and overall effectuation of coverage determinations as desired.

Pharmacy Benefit Management (PBM) Support-Audit and Delegation Oversight

Challenges abound in the most important first tier entity in the Part D benefit.  CMS expects sponsors to audit and oversight their largest FDRs.  MPDCS can provide PBM audit services for assessing their compliance of delegated operations.  Do you have a PBM oversight program in place?  MPDCS can assist in assessing or developing a robust PBM oversight program, and if a financial audit is needed as well, we can provide the necessary support.

Medication Therapy Management (MTM) and STARs

It just keeps getting more complicated and a clinical focus is paramount to success.  Improved clinical outcomes is one of CMS’ priorities.  Part D clinical initiatives significantly impact overall plan STARs performance.  Not only is the Comprehensive Medication Review (CMR) completion rate a STARs measure, CMS’ audit protocol now includes the MTM pilot.  This brings another level of scrutiny to a FDR if MTM is outsourced.

  • What is being done to oversight the in-house or outsourced MTM program CMS feels is vital to integrated care?
  • Where are opportunities for improvement for all Part D STARs measures?
  • Is enough being done to optimize the STARs program?

Whatever your needs, MPDCS has the expertise and experience to provide cost effective, timely solutions.

Our Team

Lynne Civin, RPh, MBA, presents three decades of pharmacy experience with an extensive background in Medicare Part D, dating back to the inception of the program. Before serving as a Senior Consultant at one of the nation’s largest Medicare consulting firms she worked in the Medicare Part D program at a health plan and a Pharmacy Benefit Manager (PBM). Lynne brings expertise based on years of productive direct interaction with CMS, giving her not only skills in technical compliance but also finesse in anticipation of requirements and delicate handling of scrutiny through mastery of tactful negotiation.

Pamela Martin, PharmD, is an experienced pharmacist and consultant in the Medicare Part D industry. She was a Senior Consultant at a major Medicare consulting firm having worked for a health plan and Pharmacy Benefit Manager (PBM) prior to becoming consultant. Pam offers an unparalleled focus on detail combined with her Medicare Part D expertise provides an unsurpassed ability to drill down while still maintaining a systematic and holistic approach.

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