CMS Program Audits – Preparation Is Critical

Comprehensive preparation is critical to producing accurate universes and achieving a successful CMS Program Audit. Madena’s experts have dozens of years of experience and can help Part C and D plans with all aspects of the Audit process.

How Madena Can Help With Your CMS Program Audit
CMS Program Audit
  • Development and implementation support of universe design – we perform systems review to help design universes, making sure you to get the right data out of your system(s) and into the correct universe. We can help map your data from your User Interface to the backend tables and then to the universes. 
  • Evaluate universes for adherence to instructions – we load your files into our analysis tools and provide detailed accuracy and quality checks. We then advise on any necessary data clean up and recheck your results, as many times as it takes to get it right. 
  • Review timeliness standards – our analysis tool performs checks for timeliness against compliance standards. We provide a detailed report of results and can even assist with process enhancements. 
  • Compliance Program Effectiveness (CPE) universes – we will review your universe and make sure you have not missed any reporting opportunities. We can even interview operational areas for any monitoring they are performing. 
  • Mock audits – we take the Auditor role to make sure you will be your confident best when the time comes. We will share our tips for a successful audit and make sure you correct any problems before the CMS Program Audit. 
  • Assist with guiding FDRs in the timeliness monitoring requirements – we work with your FDRs to help them get their universes correct, review their data, and perform mock webinars with them too. 
  • Project Management & Audit Support – we guide you through the entire process and are with you every step of the way.

Since 2012, Madena has bridged the knowledge gap between health plans serving the Medicare market and the government agencies they contract with. We understand the complexity of working with government healthcare programs. Our team has been leading and advising in the industry for decades—and we’ve got the tools and resources to serve you. 

By Sue Dahlkamp, Interim Compliance Officer and Senior Consultant

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