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Have you Implemented and Tested the 2022 Audit Protocols?

Now that we are through the gates of AEP/OEP season, it’s time to focus on key upcoming events: Program Audits and Timeliness Monitoring Project (TMP). Every organization will be subject to the data submissions and timeliness testing this year, either through a Program Audit or TMP.

For many organizations, this will be the first time officially using the new CMS 2022 audit protocols. Preparation is key!

“By failing to prepare, you are preparing to fail” – Benjamin Franklin

But what does preparation look like? In our experience: it is more than being able to pull data. Successful preparation needs to be end-to-end.

Here is our preparation checklist*:

  1. Utilize the 2022 protocols to create the data universes. Focus your initial preparedness on ODAG Tables 2 & 3, since these will likely be the tables required for the TMP.

  2. Test and validate the accuracy and reliability of the data pulls. The data should match the source systems and universe layout specifications.

  3. Perform analytics to identify incomplete and non-compliant records.

  4. Perform root cause analysis on any incomplete and non-compliant records. Identify where improvements in your people, processes or technology are needed for more accurate and compliant results.

  5. Repeat the steps above until you have valid, reliable results.

Unsure where to Start? for assistance with planning, preparation, or validation.

*CMS has not published the Timeliness Monitoring schedule or instructions for 2022. Our preparation checklist is based on prior years and extensive industry experience.



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