Medicare Advantage and Part D Audit Preparation and Response Services
September 5, 2011
The Centers for Medicare and Medicaid Services (CMS) has continued to increase the amount, complexity, and breadth of audits for Medicare Advantage and Part D plans. At the same time, CMS has decreased the amount of transparency in audit tools and directed plans to review the overarching regulatory and policy framework and perform its own auditing and monitoring against those requirements. FTI Consulting has had unique visibility into CMS audits and investigation protocols and can assist Medicare Advantage and Part D plans in preparing themselves for the likelihood of a CMS visit.
CMS has dramatically changed its audit protocols by relying on the large amounts of data submitted by Medicare Advantage (MA) and Part D plans and is employing a risk-based audit plan. As a result of this approach, CMS has stated that plans have access to the same types of information related to their performance as CMS. Therefore, plans are expected to have proactively identified issues and be focused on remediation steps. CMS has also made a strong connection between operational performance against Medicare requirements as an indicator of compliance program effectiveness.