Managed Care

  • 1.  Medicare Advantage Plan- Medicare Audits

    Posted 09-21-2022 01:12 PM
    Hi there,

    Just wondering if any folks out there have been through a program audit or a PI audit with CMS recently who might be willing to share any insight or lessons learned?

    My plan is currently developing a audit playbook to outline and share best practices for an audit.

    Thanks in advance!


    Jessica Sauceda
    Compliance Supervisor
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  • 2.  RE: Medicare Advantage Plan- Medicare Audits

    Posted 01-24-2023 11:35 AM
    Edited by Regina Sisk 01-24-2023 11:37 AM
    I work for a call center that sells MAPD/MA/PDPs. We have annual, bi-annual and monthly audits from the carriers who report to CMS. I have been on that end of the audit and pre-delegation part. I don't know if I would be of help but I can try.

    [Regina] [Sisk]
    [Compliance Officer]
    [Senior Healthcare Direct]

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