Getting Ready for CMS Audits
The pressure is actually on for those state-administered Medicaid programs and also those MCOs which run them. There are new initiatives being released by the CMS which promised increased program integrity with that action plan including more audits. Well the reason is because CMS has estimated improper payment rates which topped 10 percent in Medicaid in the previous year and those new initiatives are actually intended to stop 90 billion dollars of improper payment problem. It is actually well-known that MCOs such as the health plans do struggle to manage those huge volumes of data which they need to keep.
However, the CMS audit protocols would address if data is being submitted on time. This and also the promise of having more audits can leave the organization wondering if you actually have the right technology in place to endure an audit from the CMS.
The health plans these days are certainly facing an increased pressure to comply with such operational and also regulatory requirements. You have to know that compliance has really become an essential component of everybody’s job. There are demands for cost-containment and also member protection which are increasing than ever. The health plans do need such trusted and also independent and a really capable partner to navigate that regulatory environment and also provide the expertise and assurance. Those auditors can bring years of PBM, health plan, compliance, the financial and also the technical experience to those audit engagements.
For you to be ready for these CMS audits, it is very important that you are really able to prepare and you can do so with the help of the right companies that are quite knowledgeable and those which are also experienced in these matters.
There are highly structured simulated CMS audit services which are made to imitate the latest processes in CMS audits. The team of industry experts that are prepared to help the company or such organization to practice and get to learn and be familiar with the new CMS audit protocols, the new universes as well as so many other data fields, CMS protocol documents and the interviews through a webinar.
Once you have found the right company, you can be sure that they will lead the dress rehearsal and provide you with that clear picture of how the organization would perform on the CMS audit. During the mock audit, they use the latest CMS protocols and also, they adopt such position of CMS in all things from sampling to the interviews in order to provide your teams with such real thing experience. When they have the wisdom of experience, then the staff can easily move into the fix-it mode before the CMS would notify you about an audit.
All of those Medicare Advantage and also Prescription Drug Plans should make sure that they are really audit-ready at all times so that every CMS audit becomes a routine. You can save the fire drills for those fires and get standing ovations for the final performance of your organization.