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MA and Part D CMS Program Audits

A CMS Program Audit for your Medicare Advantage (MA) or Prescription Drug Plan (PDP) is a significant challenge for your Plan and your PBM to demonstrate compliance with CMS regulations; it’s like the pop quiz you know is coming. It’s a tough test…..

CMS Program Audits are conducted on short notice. A mock CMS Program Audit performed by ATTAC Consulting Group (ACG) will prepare your plan and every member of your team to be ready for an audit. We test your current compliance and coach your team through the audit process.  ACG gives you detailed insight into plan and FDR performance that provides real Return on Investment (ROI).

ATTAC Consulting Group’s mock CMS Program Audit applies the exact CMS audit protocols and testing. The audit is performed by Part C, Part D, SNP and Compliance experts in each audit domain, including clinical decision-making.

ACG’s Mock CMS Program Audit includes:

Universe Testing and Support: CMS believes the Universe is created in seven days. Audit Universes are both an IT and operations challenge. Universe readiness and testing is critical because there is so little time between audit notice and when you have to supply CMS the universes. ACG will train your staff on the ins and outs of universe requirements, evaluate data sources and test the data pulled for each CMS universe. Our team can also work hand-in-hand to identify, properly document and build out Compliance Program Effectiveness universe data.

Part C and Part D Audit Domains: ACG will conduct the audit using CMS’ current Program Audit protocol, including ODAG, CDAG, Formulary and Benefit Administration, SNP MOC auditing and Compliance Program Effectiveness. ACG can include enrollment and sales/agent oversight from the previous year’s protocol. As CMS evolves its protocol, ACG will incorporate those domains in our audit-readiness program.ACG will present identified issues and audit scoring for each domain.

Call Log Audit: As a high risk area for plans, ACG provides extensive review of your Plan’s call logs and provides feedback and examples of potential misclassifications.

Compliance Effectiveness: ACG will perform a complete Compliance Effectiveness Audit and provide you with a report and recommendations on areas in need of improvement.

Detailed Reports: We provide the scoring, issue identification and reports in the same manner as CMS so that you can be proactive in resolution development.

Why ACG? ACG is nationally known for our expertise in Medicare regulations, Compliance and Auditing. Our mock Program Audit teams have conducted myriad Compliance and Program Audits. Our audit teams use subject matter experts specialized in each and every audit domain.

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301 E. Liberty Street, Suite 605
Ann Arbor, MI 48104
T. (734) 214-2990
E. inquiry@attacconsulting.com