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2021 Program Audit Process Overview

Page 1 of 13 2021 Program Audit Process Overview Medicare Parts C and D Oversight and Enforcement Group Division of Audit Operations Updated October 2020 Page 2 of 13 Table of Contents I. Executive Summary 2021 Audit Process Timeline .. 3 II. Background .. 4 III. Summary of Audit Phases .. 4 Phase I: Audit Engagement and Universe Submission .. 5 Phase II: Audit Field Work .. 7 Phase III: Audit Reporting .. 9 Phase IV: Audit Validation and Close Out .. 10 Page 3 of 13 Phase I: Audit Engagement and Universe Submission Engagement Letter CMS notification to sponsoring organization of Audit selection; identification of Audit scope and logistics; and instructions for Audit submissions Universe Submission Sponsoring organization submission of requested universes and supplemental documentation to CMS Universe Integrity Testing CMS integrity testing of sponsoring organization's universe submissions Audit Sample Selection CMS selection of sample cases to be tested during Audit field workPhase II: Audit Field Work Entrance Conference Discussion of CMS Audit objectives and expectations; sponsoring organization voluntary presentation on organization Webinar Reviews CMS testing of sample cases and review of supporting documentation live in sponsoring organization systems via web

Corrective Action Plan (CAP) submission within 3 business days ... level, other samples are reviewed using a tracer methodology. The tracer methodology used in CPE, allows sponsoring organizations to tell the story of an issue or policy as it evolves over a period of time.

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