More Rigorous CMS Oversight and Audit Activity Ahead

By March 12, 2021March 24th, 2021Audits, CMS

More Rigorous CMS Oversight and Audit Activity Ahead

Audit notices are already hitting inboxes as CMS is kicking off a longer than usual Program Audit season this year (March through September) after an abbreviated version of the Program Audit season in 2020.  In March of 2020, CMS suspended the Program Audits to allow Plans to focus on critical operations during the pandemic. CMS then resumed a limited audit season in July of 2020. Experts agree that, with the change in Administration, a longer audit season, and the 2020 audit season experience, CMS will return to a more traditional and rigorous oversight posture with an expanded focus on challenges created by the COVID-19 pandemic.

In CMS’ last audit cycle, it conducted an average of 34 program audits each year.  For the first two years of this four-year audit cycle, CMS has conducted less than 10 program audits each year.  If CMS is planning to administer the same volume of program audits in this audit cycle, it would need to administer 60 audits in the next two years.  Given this, it seems inevitable that audit activity will increase this year. As a result, Plans who were not audited  in the past two years have a greater likelihood of being selected for an audit in 2021.

Although audit scores have improved over time, Plans continue to struggle with certain operational issues particularly those involving delegate oversight. In general, CMS’ expectation is that Plans audit scores should continue to improve as they become more familiar with executing the operational requirements and become more rigorous in their oversight and monitoring.  However with almost all businesses experiencing at least some disruption due to the pandemic, some Plans and their delegates may be a bit out of practice in their audit readiness and monitoring oversight.

To help you prepare, this issue is filled with tips and resources for audit readiness during audit season and beyond. In addition,  BluePeak is booking mock audits now with the understanding that the mock audits can convert to audit support as needed.  Contact us today for a free consultation on your audit readiness.  And read on for more audit readiness strategies.