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CMS Releases 2022 Audit Protocols

With the 2021 Program Audit in full swing, CMS released the Program Audit Protocols for 2022 on May 26, 2021.    The 2022 protocols are very similar to what was previously proposed for the 2021 audit protocols.  The final protocols are available for download here (please see “Final Protocols for the Medicare Part C and Part D Program Audits and Industry-Wide Part C Timeliness Monitoring Project (CMS-10717)” zip file).

CMS highly encourages organizations to review these protocols, including the crosswalk of changes that occurred after the 30-day comment period, in preparation for 2022 upcoming audits.  Plans should also being working with internal partners and their delegates to revise the universes as required.

Following is a summary of general changes:

  • Newly added templates
  • Standard attendance template has been added
  • Standard root cause analysis form has been added
  • CDAG/ODAG Universe consolidation
  • Universes have been consolidated
  • Fields have been added to the consolidated universes to delineate between processing timeframes (standard / expedited)
  • Technical Changes
  • Medicare Beneficiary Identifier (MBI) has been replaced with Enrollee ID
  • Value changed from ‘NA’ to ‘None’ for all applicable program areas
  • Data Integrity changes
  • All program areas are now subject to data integrity (new CPE, FA, and SNP)
  • Samples volume has been adjusted to account for the consolidation of universes
  • CMS noted they will review all cases selected or documentation received for universe integrity testing
  • The integrity of the universe will be questioned if the cases selected and/or documentation reviewed during the audit does not match the data provided in the universe
  • Audit detail
  • CMS added ‘Method of evaluation’ column to provide additional information on samples targeted during the program audit sessions
  • CMS added ‘Criteria’ column to document the regulatory compliance standards for each of audit element

If you have not already received a copy of BluePeak’s detailed protocol change summary, contact us today for your free copy.