A CMS Program Audit for your Medicare Advantage or Prescription Drug Plan is a Significant Challenge

CMS Program Audits are conducted on short notice. A mock CMS Program Audit performed by ATTAC Consulting Group 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.  We give you detailed insight into plan and FDR performance that provides real return on investment.

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.

CMS Program Audits Capabilities Brochure

Organization Determination, Appeal, Grievance (ODAG) & Call Center Classification Capabilities Brochure

Medicare Part D Audit Capabilities Brochure

ATTAC’s Mock CMS Program Audit includes:

Utilization (UM) Focused Audits: As part of the 2024 Medicare Advantage and Part D Final Rule, CMS announced that utilization management (UM)-focused audits will be used to test plan and FDR compliance with new UM program guidelines. ATTAC’s clinical and compliance experts will help your plan prepare for a UM-focused audit; we also provide post-audit corrective action and remediation support.

Universe Testing and Support: 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. We 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: ATTAC will conduct the audit using CMS’s current program audit protocol, including ODAG, CDAG, formulary and benefit administration, SNP MOC auditing and compliance program effectiveness. We can include enrollment and sales/agent oversight from the previous year’s protocol. As CMS evolves its protocol, we will incorporate those domains in our audit-readiness program. ATTAC will present identified issues and audit scoring for each domain.

Compliance Effectiveness: We will perform a complete compliance effectiveness audit and provide 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 you can be proactive in resolution development.

Optional Call Log Analysis: While CMS no longer includes call log review as part of program audit, having ATTAC analyze your call logs can provide tremendous insight into CSR operations and helps identify potential misclassifications.

ATTAC is nationally known for our expertise in Medicare regulations, compliance and auditing. Our mock program audit teams have conducted myriad compliance and program audits. We work with subject-matter experts specialized in each and every audit domain.