When it comes to healthcare and medical insurance audits, the Centers for Medicare & Medicaid Services (CMS) program audits stand out as a critical aspect. These audits are designed to ensure compliance and integrity within the healthcare industry. Here are eight best practices for conducting effective CMS program audits.
1. Develop a Standardized Work Plan
Ensure that your audit work plan is developed following standard testing procedures. A standardized approach ensures consistency and reliability in your audit findings.
2. Understand the Audit Process and Protocols
Familiarize yourself with the Program Audit Process and Protocols provided by CMS. This understanding will guide you through the different stages of the audit process.
3. Implement Self-Audits
Conduct self-audits within your healthcare practice or business. Self-audits help identify potential areas of non-compliance before a formal CMS program audit.
4. Prepare for Routine and Focused Audits
In 2024, both routine and focused audits will be conducted by CMS. Preparing for these audits ensures that you’re ready for any scenario that may arise.
5. Include Self-Identified Areas of Risk in Your Audit Plan
Your audit plans should not only include aspects included in CMS’ protocol but also audits of other self-identified areas of risk.
6. Incorporate Both External and Internal Auditing
A well-designed compliance program should include both external and internal auditing. This dual approach can offer more comprehensive insights into your operations.
7. Leverage Technology in Audit Response Management
Technology can be instrumental in managing audit responses. It can streamline the process and increase efficiency.
8. Hire an Expert Professional Team
Engage an expert professional team to conduct your annual CMS program audits. Their expertise can help you improve your compliance and readiness for the CMS audits.
By following these best practices, you can ensure that your healthcare organization is prepared for CMS program audits and capable of addressing any compliance issues that may arise.