Many Medicare Plans may believe compliance with the ten-year record retention requirement is a slam-dunk. However, plans are often tripped up in audits because their first-tier and downstream entities do not adhere to the same record retention requirements.
An example of this is in the Financial audits, which require hard copies of prescriptions be provided. Some states only require pharmacies to keep prescription hardcopies for one-year and pharmacies and their PBMs mistakenly fail to ensure appropriate record retention until documentation requests are made as part of an audit request. Contracts generally contain the correct mandated 10 years retention; however evidence is not monitored regularly.
Although state law may not require a Part D sponsor to participate in any state audits after a specified time period from the date of service, federal regulation mandates participation for 10 years after the date of service. Part D sponsors must maintain records, documents, books, and other evidence of accounting procedures and practices for 10 years, per 42 Code of Federal Regulation (CFR) §423.505. The 10-year records retention requirement also applies to the Part D sponsor’s first tier and downstream entities as per 42 CFR §423.504(i). Part D sponsors’ first tier and downstream entities must contractually agree to audits and inspections by CMS and/or its designees, to cooperate, assist, and provide information as requested, and to maintain records for a minimum of 10 years.
Don’t be complacent that your FDRs, know the rules. Make sure record retention and other CMS requirements are part of your monitoring programs, call BluePeak for more information.