From article ABSTRACT:

The audit protocols and process updates released in February 2015 contained significant revisions that resulted in difficulties for plans to prepare for an audit. Because of feedback received and experiences from audits, CMS revised and republished the audit protocols in October of the same year.

Medicare Part C and D plans will need to review and react accordingly to the revisions contained within the audit protocols, particularly the modifications to the record layouts, updates to the Impact Analysis templates, impact of the new Invalid Data Submission condition, and changes to the Compliance Program Effectiveness protocols. With CMS’ data-driven approach to audits and increased scrutiny on data accuracy, plans must invest the time and resources required to prepare for an audit, including robust quality assurance testing. All too often, audit failures result in mandatory corrective actions and enforcement actions, including civil monetary penalties levied by CMS.

As the Medicare audit process and protocols evolve, plans must be flexible and react to the changes. Failure to adapt will result in consequences far greater than audit failure alone.

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