Ready or not-the 2018 Audit Season is Upon Us…
As Plans Continue to Struggle with the Same Common Conditions, CMS Makes Few Changes from the 2017 to 2018 Audit Protocols  

As the Centers for Medicare and Medicaid Services (CMS) begins sending program audit engagement letters this month, plans may have noticed changes from the 2017 to 2018 protocols are minimal. As CMS enters the last year of this audit cycle (2015-2018), plans continue to struggle with the same common conditions these protocols were designed to identify. Click to read all the changes from the 2017 to 2018 CMS program audit protocols.
Highlights of CMS-Proposed Changes in Draft 2019 Call Letter

The Centers for Medicare and Medicaid Services (CMS) proposes changes to Star Ratings, validation audits, annual Compliance Program Effectiveness (CPE) audits, Part D opioid overutilization policy, and more in the draft 2019 Call Letter that was released February 1.
Appeals and IRE Data Issues Can Impact Audit Scores, Star Ratings and CMPs
 
Whether deficiencies are discovered as part of a CMS program audit or a Timeliness Monitoring Project (TMP) review, issues with appeals and Independent Review (IRE) data can impact a plan’s Star Ratings and result in CMS enforcement actions, including Civil Money Penalties (CMPs).
BluePeak Service Spotlight:
Mock Audits with UMS and Call Log Reviews

BluePeak has conducted over 150 CMS mock audits and onsite support projects for clients undergoing actual CMS program audits. We also offer mock audit breakouts, such as our Universe Monitoring Service and Independent Call Log Review. Contact us today for a free consultation.
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