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Industry Alert: Is Your Health Plan the Target of CMS’s New Audit Focus?

February 3rd, 2017 | by Brad Boyer

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Vikki Ahern, CMS Director for Medicare Part C/D Oversight and Enforcement Group (MOEG), spoke at this week’s 2017 HCCA Managed Care Compliance Conference. It served as a wake-up call for compliance professionals in attendance.

Although an explanation of CMS’s reasoning was not provided, Vicki Ahern stated that CMS will specifically target small parent plans for 2017 program audits. CMS will begin sending plan sponsor program audit notices on February 21, with audit start dates in April.

Cody’s observation of the marketplace is that a significant number of small plan audits by CMS in 2015 and 2016 resulted in extreme deficiency findings. In the plan audits performed by Cody over the past year for small plans, this was also the norm. If you are a small plan, you may also have significant deficiencies and not be aware of the severity of noncompliance – or the level of risk and penalties you may be facing.

Ahern further expressed that CMS fully expects that plan sponsors will engage their “first tier entities” in their program audits. These entities must attend the audit webinars, and also be available immediately and as necessary when the webinars begin.

Are you prepared? Most plans believe they are. But Cody’s findings (and, more importantly, CMS’s findings) show otherwise. So now what? With audit notices commencing on February 21, time is of the essence. To most-effectively prepare for CMS’s 2017 audit process, Cody can help your health plan prepare through the following services:

  • CMS Audit Workshop – Learn what you need to know before receiving your audit letter, how to present data universes and tracer issues to CMS, what the audit experience entails, and more.
  • CPE Mock Audit
  • Full Program Mock Audit
  • On-site support for CMS audit preparation and response

For more information about how you can ensure you achieve compliance with industry and regulatory standards, please contact us today.

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