MPD Compliance Specialists, LLC – Medicare Part C and Part D Consulting, Independent Auditors

Company Info

Medicare Part C and Part D Compliance Specialists LLC (MPDCS) is an independent consulting firm founded and operated by two Medicare Part D pharmacists who worked for a large Medicare consulting firm. 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 comprehensive 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 Advantage/Prescription Drug Programs are a complex benefit to administer. MPDCS can help you navigate efficiently through maximizing your operational practices, understanding both health plan and FDR 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 FDRs 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 staff have both FDR and health plan experience that can assist you in moving into the stream of compliance and continued success.

Part C, Part D and CPE Mock Audits, 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. Helping you prepare for the audit, assist with responses to CMS and post remediation work is our specialty.

MPDCS has extensive experience in assisting and auditing CPE, Part D and Part C, including SNP-MOC and MMP, program areas.

Formulary and Benefit Testing Assessment, Prescription Drug Event (PDE) Audits

Did you have time to work with your PBM to review and assess your formulary and benefit configuration for the upcoming contract year? 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. With the TMPA and FAA programs, there is little room for mistakes.

Are you sure your PDE is accurate that can impact payment reconciliation? PDE is the basis for Plans’ final payments meaning your bottom line. What oversight is Pharmacy or Finance performing on the PDE? MPDCS has analytic tools beyond compare.

Independent Auditor (IA) Validation Process

When CMS requires your organization to hire an Independent Auditor to validate the correction of deficiencies found during your full or partial CMS program audit, look to MPDCS. MPDCS will collaborate with you and develop the IA workplan during that stressful time of remediation and defining clean periods. MPDCS has extensive experience in the IA Validation process and CMS has even complimented MPDCS on their consumable workplan as very easy to read, review and understand. Contact us for a quote for your IVA.

FDR Audits, Internal Monitoring and Delegation Oversight

Challenges abound Sponsor in managing their FDRs in Medicare Advantage/Prescription Drug Program. Sponsors must audit their operational areas and those of their first-tier entities. This should include internal monitoring and audits and, as appropriate, external audits, to evaluate the Sponsor’s, including FDRs’, compliance with CMS requirements. MPDCS can provide FDR/PBM audit services for assessing their compliance of delegated operations. Do you have a FDR/PBM oversight program in place? MPDCS can assist in assessing or developing a robust FDR/PBM oversight program, and if a financial audit is needed as well, we can provide the necessary support.

STARs, and Medication Therapy Management (MTM)

It just keeps getting more complicated and a clinical focus is paramount to success. Improved clinical outcomes is one of CMS’ priorities. Part C and D clinical initiatives significantly impact overall plan STARs performance. Where are opportunities for improvement for all Part C and Part D STARs measures? Is enough being done to optimize the STARs program?

The MTM Comprehensive Medication Review (CMR) completion rate is a STARs measure. Although currently MTM is no longer a pilot audit protocol, will you be ready if it returns? What is being done to oversight the in-house or outsourced MTM program CMS feels are vital to integrated care?

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

Our Team

Lynne Civin

Pamela Martin

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.