CMS Audit Cycle - 2019

CMS originate a new audit phase in 2019 and believe the length will be consistent with preceding phases. While sponsoring organizations are usually audited once per audit cycle, CMS can audit a sponsoring organization more than once throughout the cycle based on risk or audit referral.

The objective of this audit is to rise transparency associated to the Medicare Advantage and Prescription Drug Plan program audits and other several types of audits to help drive the industry on the way to developments in the provision of health care services in the Medicare Advantage and Prescription Drug program.

CMS conducts program audits of MMPs (Medicare-Medicaid Plans), Medicare Advantage Organizations, and Prescription Drug Plans, jointly stated to as "sponsors". CMS Medicare Advantage Parts C and D program audits for sponsors that contain and MMP utilize the Center for Medicare Program Audit Protocols as well as two MMP-specific protocols aimed to make sure compliance with three-way contract requirements in the following areas:

1- MMP Care Coordination & Quality Improvement Program Effectiveness (MMP-CCQIPE) Program Area.
​2- MMP Service Authorization Requests, Appeals and Grievances (SARAG) Program Area.