Is your audit season soon?
Is your audit season soon? Here’s a friendly reminder. In December, CMS sent a memo about the 2024 program audit updates slated for the upcoming audit season. Medicare Advantage and Medicaid plans should have been reminded of the April 2023 rule change which implemented new requirements which are subject to audit and review this review season. Those areas include: coverage criteria for basic benefits, the use of prior authorization, the added requirements around continuity care and the required annual review of utilization management tools.
Government program health plans – make sure you’ve reviewed your policies and procedures, you’ve documented the inclusion of these new requirements and training on these requirements. The goal is to ensure that you are able to show clearly and concisely that you have been compliant with the requirements. For some, there may be an opportunity to actually document what has already been done, but if you haven’t started, now is the time to do so.
Reach out if SunHawk Consulting can assist – we can help with staff augmentation and support as independent auditors, or as part of your audit preparation team.
Don’t wait until you receive your audit notice to prepare for your audit. We are here to help.
Kimulet Winzer
Director
SunHawk Consulting, LLC
[email protected]
Kimulet Winzer has 25 years of Medicaid managed care experience. She’s worked with healthcare providers, advocates, regulators, payor plans, attorneys, vendors, lobbyists and healthcare leaders on a myriad of operational remediations, innovations and core compliance program development, implementations and training. Most recently she served in a leadership role with UnitedHealthcare as a regional compliance director for the Medicaid program. Prior to her 13 years with UnitedHealthcare she helped to build and implement Medicaid and Medicare DSNP Compliance programs; oversee member and provider grievance and appeal processes and help in the understanding of regulatory changes impacting the delivery of managed Medicaid services and programs.
SunHawk experts are highly experienced professionals ready to assist you within our focus areas of:
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Corporate Compliance | Litigation Disputes
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