Compliance Program Effectiveness Review & Audit (CPE)

Get More Out of Your Annual CPE Review

CMS guidance states that Medicare Advantage and Part D plans should have a third-party annually review Compliance Program Effectiveness (CPE). CMS has noted a condition in plan program audits when an annual third-party CPE review has not been completed.

When you want to do more than “check the box” and get a real return on investment from an annual CPE review, contact ATTAC. We’ve performed CPE reviews for large, medium, and small plans for more than 15 years. Our team provides insight and expert guidance on potential risks and how to develop and apply best practices, regardless of plan size.

See our CPE capabilities brochure

ATTAC Works With Your Schedule to Perform an Annual CPE Audit and Review

  • We conduct an educational session with staff on CMS expectations and current audit focuses
  • We review all CPE universes using our unique “bottom-up” analysis approach, looking for gaps, potential risk areas and the “story” they tell CMS
  • We review all supplemental questionnaires and documentation, providing guidance on gaps and/or areas to address
  • We conduct six tracer samples, based on your universe data and current CMS areas of interest and high-risk areas; we also offer a three-tracer sample option

Our reporting provides an assessment of how CMS will view your Compliance Program Effectiveness. ATTAC’s guidance and recommendations help plans make enhancements and mitigate risk.

Contact ATTAC for an annual CPE audit proposal

“I used ATTAC for my organization’s Compliance Program Effectiveness (CPE) review. The team was professional and very knowledgeable about CMS audit protocols, guidance and regulations. They were thorough, prompt and very insightful in their feedback and recommendations.” – Medicare Compliance Officer, National PDP Plan

Our Three-Step Audit Methodology and Approach

Step 1

We use the latest version of CMS compliance program effectiveness protocols as the basis for the assessment, and apply the revised Medicare audit period to universe review, tracer sample selection and tracer reviews.

Step 2

Our subject-matter experts review universe and supplemental documentation to analyze how the plan’s activities and outcomes prevent, detect and correct operational non-compliance and potential fraud, waste and abuse. We also provide training on how to prepare comprehensive tracer case summaries.

Step 3

We prepare a detailed report with findings related to each major area of review and address the three compliance-cycle activities and seven compliance elements CMS assesses.