CMS Audit Findings and Operational Implications

Event Date: 2/20/2019

Event Overview

Wednesday, February 20, 2019
1:00 CT - 2:30 CT (90 minutes)

This event is hosted on our ReadyTalk platform

In this informative session, Dr. Babette Edgar and Michelle Rigby of BluePeak Advisors will discuss the 2019 CMS Compliance Program Audit process from selection to audit resolution, as well as lessons learned from the 2018 CMS Audit Season for these audit areas. Formulary Administration (FA), Coverage Determinations, Appeals and Grievances (CDAG), Organizational Determinations, Appeals and Grievances (ODAG), Special Needs Plans Model of Care (SNP MOC), Compliance Program Effectiveness (CPE), in addition to the new Medicare Medicaid Plans (MMPs), that can be used to prepare for 2019. In addition she will review potential changes for the 2020 audit year that are currently in OMB. Discussion will also include best practices for CMS Program Audits facilitation and remediation.

• Describe the most common findings from CMS Program Audits in 2018
• List the changes in CMS Program Audit practices for 2019
• Discuss the potential changes to CMS Program Audits that may occur in 2020

Audience

Leaders with responsibility for Medicare Advantage program management and oversight in addition to Compliance, Pharmacy, Medical Management, and Operations teams .

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Documents

2/20/2019

Presentation: BluePeak Advisors_CMS Audit Findings and Operational Implications
BluePeak Advisors' Babette Edgar and Michelle Rigby discuss the 2019 CMS Compliance Program Audit process from selection to audit resolution, as well as lessons learned from the 2018 CMS Audit Season for these audit areas.