I really hope I get a CMS Program Audit notice this season… Said no one ever!

By March 15, 2019Audits, CMS, Tips

But, ready or not, CMS Program Audit Season is here! Wouldn’t it be great to know that you have done everything possible to prepare in the event you get a Program Audit notice?

Here are some tips and tricks to prepare as audit season gets underway for 2019. Call BluePeak if you need assistance with preparation, mock audits or audit support. We are here to help!

Helpful Tips
  1. Ensure your plan and all of its delegates can produce accurate universes, without delay.  If you are not already producing and reviewing universes on a monthly basis, start doing so now.
  2. Have a plan for resources and have a contingency plan.   Audits tend to happen at the worst possible time-when that key resource has a vacation planned or is getting married. Know who your ideal audit support team is and identify back-ups. You should make sure your delegates have a similar plan too.
  3. It is not too late to do a mock audit.   Mock audits are a great way to test for issues and know where your Plan’s areas of weakness (or strength!) reside.
  4. Make sure your plan is familiar with the 2019 protocols.  While the changes were not extensive, you will want to be familiar with the new expectations.
  5. Familiarize yourself with the recently published CMS Program Audit FAQs. CMS published this helpful guide in February 2019 in which CMS provided answers to the Program Audit questions they received most frequently in 2017 and 2018.
  6. Think past the audit.  There will likely be findings which could result in Immediate Corrective Action Plans (ICAR), Corrective Action Plans (CAR), remediation, clean periods and validation audits. BluePeak offers training on how to write effective Corrective Plans, getting through the clean period and what to expect during an Independent Validation Audit. Think about training now so that you and your team are prepared.
  7. It is never too late to prepare for 2020.  Keep an eye out for the 2020 protocols, expected to be released in the Spring 2019.
  8. Need help?  Ask BluePeak.  BluePeak has helped numerous Plans successfully navigate CMS Program Audits. Experience and knowledge may be just what you need to help keep that audit score as low as possible.