How to Efficiently Conduct an Audit

Audits from regulatory bodies swarm around an organization like bees.  And like a bee, upon first sight we do not think of the value they bring, but instead we first think of the sting that is to come.

A key aspect of an effective compliance program is to ensure there is an effective system for routine auditing and monitoring along with a system to identify compliance risks.  You’ve established what you believe to be a solid audit plan for the year, but other things just seem to get in the way.  First, you’re tasked with researching the requirements for a new plan type.  Then you have a fire to put out with a delegate.  One of your staff gets a job offer she can’t pass up, and before you know it, your audit schedule for the year is derailed.  You’ll get to them, right?  Let’s just hope you don’t receive an audit letter in the meantime.  With every passing Monday you hold your breath, all the while wondering how much time it will be before the inevitable occurs.

Sometimes an extra set of hands is all that’s needed to get your audit activities back on track, but you do not have the budget for another full-time employee. Think of the following member-impactful audits that can be accomplished while you handle other responsibilities:

• Part C and Part D Grievances and Appeals
• Member Enrollment and Disenrollment
• Marketing
• Coordination of Benefits

All audit plans should include not only aspects included in CMS’ protocol but also include audits of other self-identified areas of risk.  Any operations that touch member service or payment might be considered higher risk on your assessment.  Are they?  And are you able to accomplish them all with the resources you have? Does your staff have the right skillset for the audits? From a CMS Q&A:

The safeguarding of beneficiary rights and protections is arguably the most important responsibility of a sponsor.  Demonstrating you have the resources to detect, correct, and prevent occurrences of non-compliance is a struggle when a department lacks things like the time, resources, or skill to perform certain audits.  Contact us for ideas on how we can partner with you to efficiently conduct some of your audits, providing you with some much needed assistance.

Resources

The Centers for Medicare & Medicaid Services (CMS) audit practices have undergone a few changes in recent years, but the core focus remains the same: beneficiary protections. From a gap analysis to a comprehensive, deep-diving Part C and D audit, our team can help you minimize your compliance risk and maximize your time and resources. Visit our website to learn more about our audit services >>

On Tuesday, September 13, 2016, from 1:00 — 2:00 pm ET, join colleagues Diane Hollie, Senior Director of Sales & Marketing Services, and Carrie Barker-Settles, Director of Sales & Marketing Services, as they outline the keys to building an integrated member experience program that will deliver a significant and positive impact on health plan enrollment, retention, and revenue generation. Register now >>

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