CMS Audit Preparation for Provider Data Accuracy and Compliance
For health plans, a CMS program audit failure can trigger financial penalties, sanctions and even enrollment freezes. PRIME’s CMS mock audit services assist Health Plans with preparing to respond to a CMS provider directory audit successfully.
The Centers for Medicare and Medicaid Services (CMS) is a federal Health and Human Services agency that administers major federal and state health care programs in the U.S. In addition to Medicare and Medicaid, it also oversees the Children’s Health Insurance Program and state and federal health insurance marketplaces.
As part of its mandate, CMS collects and analyzes data, releases research reports, and works to eliminate fraud and abuse within the nation’s health care systems. It also conducts various audit programs designed to measure a health plan’s compliance with the state and federal regulations, including provider directory accuracy.
All health plans with providers that treat Medicare and Medicaid patients are subject to CMS auditing. Complying with CMS regulations is challenging for Health Plans and a CMS audit is almost a certainty these days. One way to ensure a successful audit is by performing mock audits based on the same criteria official auditors use.