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2021 Program Audit Process Overview - CMS

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.

substantially corrected and notification of next steps or audit closure. I. Executive Summary – 2021 Audit Process Timeline . Page 4 of 13 ... CMS uses the feedback to update and improve audit operations as well as ... by CMS through on-going monitoring or other account management/oversight activities during the plan

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