Mock CMS Audits and Focused Audits
This highly structured service analyzes your health plan’s and/or prescription drug plan’s operations and replicates the actual CMS audit processes.
This service gives your organization the opportunity to identify and address compliance issues before CMS finds them. We’ll review your organization’s documentation (such as policies and procedures and workflows), sample up to hundreds of case files, and conduct staff interviews -- just as CMS does during an audit.
We’ll issue a detailed element-by-element report of how your organization would likely perform in an actual CMS audit, and share best practices for attaining and maintaining compliance. Plans that score poorly during our mock audit are well-positioned to move quickly into “fix-it” mode -- long before CMS notifies you of a pending audit.
This service is recommended for health plans and sponsors looking for an independent risk assessment.
Types of Mock CMS Audits Available:
- MOCK CMS AUDIT-Part C Only
- For any Medicare Advantage (MA) Plan
- Includes applicable elements from the applicable Medicare Advantage Audit Guide
- MOCK CMS AUDIT-Parts C and D
- Specifically for MA Plans with Part D (MA-PD)
- Includes applicable elements from the Medicare Advantage and Part D Audit Guide(s)
- MOCK CMS AUDIT-Part D Only for MA-PD
- Includes applicable elements from the MA-PD Part D Audit Guide
- MOCK CMS AUDIT –Part D for PDP
- Includes applicable elements from the PDP Part D Audit Guide
- MOCK CMS AUDIT –Part D for delegated PBM
- Includes elements delegated by the Plan to the PBM from either the applicable MA-PD Part D or PDP Part D Audit Guide
- MOCK CMS AUDIT–Fraud, Waste and Abuse (FWA) for Part C and D
- For MAs, MA-PDs, PDPs and PBMs
- Includes an audit of the requirements as specified in 42CFR 422 and 423 and Chapter 9 of the Prescription Drug Benefit Manual
