Rise

Be ready for your next CMS audit with this practical checklist. Designed for Medicare Part D plan administrators, compliance officers, and PBMs, this guide walks you through the stages of audit readiness-helping you avoid common pitfalls and ensure compliance.

1. Understand the CMS Audit Process
   • Review Audit Protocols: Familiarize yourself with the latest CMS Program Audit protocols and guidance documents.
   • Know the Audit Types: Identify applicable audits (e.g., Program Audit, Timeliness Monitoring) using the CMS Audit Process Overview PDF.
2. Assign Roles and Responsibilities
   • Designate an Audit Lead: Appoint a compliance officer with expertise in CMS regulations.
   • Build Your Audit Team: Include staff from compliance, pharmacy, IT, and member services.
3. Gather and Organize Documentation
   • Create a Central Repository: Use CMS’s EHR Audit Prep Checklists as a template for organizing records.
   • Prepare Key Documents: Policies, formulary documentation, and training records.
4. Conduct a Mock Audit
   • Use CMS Tools: Follow Guidehouse’s mock audit guidelines for process simulations.
   • Identify Gaps: Address issues using Cody Consulting’s software integration tips.
5. Train Staff
   • Audit Readiness Training: Enroll teams in CMS’s Part C/D web-based courses.
   • Role-Playing Exercises: Simulate audits using Mirra Healthcare’s case study examples.
6. Review and Update Policies
   • Annual Policy Review: Align with Bates Group’s CMS policy framework.
   • Document Changes: Track updates using CMS’s audit reporting templates.
7. Prepare for Onsite/Virtual Audit
   • Confirm Logistics: Review CMS’s Phase II field work requirements.
   • Assign Point Persons: Designate contacts per Bassberry’s audit response guide.
8. Respond Promptly During the Audit
   • Timely Submission: Meet deadlines outlined in CMS’s audit timeline PDF.
   • Clear Communication: Use Bassberry’s audit interface strategies.
9. Address Audit Findings
   • Develop Corrective Action Plans: Submit via CMS’s Plan of Correction Form (CMS-2567).
   • Track Progress: Follow CMS’s validation audit work plan guidelines.
10. Continuous Improvement
    • Debrief with Team: Apply insights from Cody Consulting’s post-audit review tips.
    • Update Checklist: Incorporate lessons from CMS’s validation audit protocols.

Downloadable Resources

• CMS Audit Process Overview PDF
• Plan of Correction Template (CMS-2567)
• Mock Audit Guide (Guidehouse)