Medicare Advantage: Making Sense of the Audit Universe

 In Productivity & Management

Managing the highly regulated areas of Medicare Parts C and D can be a daunting challenge for health plans. Factor in a CMS audit, and the complexity and associated administrative burden can skyrocket.

On today’s program, Change Healthcare Consulting’s Phillip Cardona, Melissa Bailey, and Tim Gundlach explain CMS audit universes; managing the considerable amount of data they can require; and best practices for preparing for and facilitating the audit process.

Here’s what they reviewed:

  • CMS and the role of “audit universes” (00:34)
  • What audit universes mean to health plans (01:55)
  • Audit universes defined and how they’re changing next year (04:18)
  • Recommendations for providing “clean” universes to facilitate the audit process (09:39)
  • Best practices for ensuring accurate data sources (11:43)
  • Preparing for the data validation webinars with auditors (13:13)
  • The need for periodic monitoring (14:32)
  • How a Medicare audit tool can help reduce the administrative burden (16:25)

Episode Resources

  1. Phillip Cardona’s bio
  2. Melissa Bailey’s bio
  3. Tim Gundlach’s bio
  4. Consulting Resource Center
  5. Change Healthcare Consulting Services

Show Resources

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