External Audit Program

 

Get the additional audit assistance your organization needs

 

At Gorman Health Group we know how difficult is it to carry a standard workload, ensure proper monitoring and focus on correction. All organizations are faced with ever-changing CMS guidance, budgetary pressures and the need for additional resources, making it harder for even the best organizations to meet the demands of the annual compliance work plan, assessment of CMS audit protocols and other auditing needs.

 

To build and maintain an auditing program that operates within CMS guidelines means overcoming challenges with resources and with maintaining extensive documentation. Meanwhile, overseeing internal and delegated functions within your organization has challenges of its own. CMS has identified many instances of insufficient auditing of these processes in recent audits.  The results in many cases have uncovered adverse member impact and resulted in CMS issuing Immediate Corrective Actions Required (ICARs) requiring a delivered Corrective Action Plan within three business days. It’s enough to make you want to hire a stealth Compliance Task Force.

 

GHG now offers an external audit program that evaluates compliance with regulations, CMS guidance and internal policies and procedures to protect against noncompliance and Fraud, Waste and Abuse.  Our external audit program provides the rigor you expect from GHG in the most cost-effective manner possible.  The external audit program includes a review of requested universes to identify potential systemic data integrity issues, virtual and onsite sample case file and documentation review in order to determine functional area compliance or lack thereof. The GHG audit protocol is modeled after the most recent CMS audit protocols. Every audit results in a final written report, which provides the organization with findings related to areas of noncompliance. GHG also offers the option to provide best practices and recommendations for addressing deficiencies

 

The external audit program process is fully customizable according to your organization’s needs and can encompass both internal and delegated functions, CMS audit protocol, as well as the inclusion of other audit elements that are not part of the current protocol (e.g. enrollment, credentialing, member services).  Don’t let CMS be the first to tell you where your deficiencies are.

 

 

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