Seven Keys to a Successful CMS Audit

Progressive thinking organizations are more and more looking at an audit as a verification process to ensure that their compliance and operational procedures are in order and to unearth opportunities for improvement that might lead to more effective management and the minimization of errors in the future.

Here are seven things compliance can do to help assure that happens:

1. Take the lead in interpreting and providing clarification of the protocols CMS provides to company leadership so as to assure consistent knowledge among all parties within the health plan.
2. Conduct mock CMS audits department by department that include mock compliance program effectiveness audits as well as mock tracer audits to support readiness and familiarity with that critical part of the audit process.
3. Conduct educational conferences throughout the year at which time new and existing CMS guidance is explained.
4. Join with operations to identify and fully educate internal “accountable owners” who will be responsible for providing the data the auditors will need.
5. Vigorously encourage senior leadership to be involved throughout the prep work and during the audit as their support, encouragement and validation send an important message as to the importance of this activity.
6. Work with operations to create a central, shared location for all audit materials and submissions and establish tracking logs to record the status of all deliverables.
7. Let it be known that the compliance team is available to provide regulatory assistance at any time and that anyone engaged in the audit process should feel comfortable in turning to compliance to ask questions and get clarification so as to assure audit readiness.

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