CMS Program Audit Prep: Leveraging Your Appeals & Grievances Software

Happy New Year and ‘tis the season for CMS Program Audits!  In the 2024 CMS Program Audit Updates memo released on December 19, 2023, CMS confirmed their plans to conduct both routine and focused audits of health plans in 2024. The new focused audits will assess compliance with the coverage and utilization management (UM) requirements finalized…

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Are You Prepared for Your Next CMS Program Audit?

Preparation is critical to produce accurate universes and achieve successful CMS Program Audit results. In November 2021, CMS announced they will send program audit engagement letters to sponsors, starting in February through July 2022. If you ask yourself when should your readiness for a program audit begin? The answer is NOW! CMS made several significant…

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