2015 CMS Audit Protocols – Are You Prepared?

, , Babette Edgar

Helaine Fingold, Senior Counsel, Lynn Shapiro Snyder, Senior Member of the Firm, and Babette Edgar, a Strategic Advisor at EBG Advisors, will present "2015 CMS Audit Protocols - Are You Prepared?" a webinar hosted by Health Plan Alliance MAC. 

On February 12, 2015, the Centers for Medicare & Medicaid Services (“CMS”) released its updated Medicare Advantage (“MA”) and prescription drug benefit (“Part D”) plan audit protocols for 2015, also announcing the beginning of a new audit cycle. Under the new cycle, CMS will consider all plan sponsors for audit, even those audited during the previous (2010-2014) cycle. CMS modified the universe submission process for two of the currently targeted program areas, substantially revised the protocol on another, and added two new program areas on a pilot basis. With these sweeping changes, the most important question is “Are you prepared?” 

This session will help attendees prepare for upcoming CMS audits including: an overview of the new audit process, preparing for submission of documentation, discussion of issues likely to be addressed, and a real-life information from a 2015 audit completed under the new protocol. The educational objectives of this session are:

  • Understand the implication of the 2015 audit cycle and how this may impact an individual sponsor’s selection for audit
  • Understand the changes in how sponsors will submit CDAG and ODAG universes and the potential impact this will have on timing and activities of the audit
  • Learn about CMS’ new approach to assessing Compliance Program Effectiveness and how to prepare
  • Hear about CMS’ announced pilot areas for audit and the likely issues to be targeted through these modules