Audit Report - Cms Reprioritization Of Pace Medicare Parts C And D Program And Risk Adjustment Data Validation Radv Audit Act

Summary

A memorandum from the Centers for Medicare & Medicaid Services (CMS), dated March 30, 2020, addressed to Medicare Advantage organizations, Part D sponsors, Medicare-Medicaid Plans and Programs of All-Inclusive Care for the Elderly (PACE) organizations. Its subject is the reprioritization of PACE, Medicare Parts C and D Program, and Risk Adjustment Data Validation (RADV) audit activities. CMS states that it is reprioritizing program audits until further notice and will shift oversight toward noncompliance where beneficiaries' health or safety is at serious risk, and complaints alleging infection control concerns. It also states that CMS is suspending RADV activities related to the payment year 2015 audit and will not initiate additional contract-level audits until the public health emergency has ended.

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Issuer: Congressional materials
Document type: Audit Report
Case: Cms Reprioritization Of Pace Medicare Parts C And D Program And Risk Adjustment Data Validation Radv Audit Act

Cite this document

“Audit Report - Cms Reprioritization Of Pace Medicare Parts C And D Program And Risk Adjustment Data Validation Radv Audit Act.” Original at cms.gov. Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/cms-reprioritization-of-pace-medicare-parts-c-and-d-program-and-risk-adjustment-data-validation-radv-audit-act/, SHA-256 635932a232d121c880b489fac05e0c5f430f6a873cd58601e0d7805808235180.

Full text

DEPARTMENT OF HEALTH & HUMAN SERVICES
Centers for Medicare & Medicaid
Services 7500 Security Boulevard
Baltimore, Maryland 21244-1850


DATE:              March 30, 2020

TO:                All Medicare Advantage Organizations, Part D Sponsors, Medicare-Medicaid
                   Plans, and All Programs of All-Inclusive Care for the Elderly (PACE)
                   Organizations

SUBJECT:           Reprioritization of PACE, Medicare Parts C and D Program, and Risk Adjustment
                   Data Validation (RADV) Audit Activities

The Centers for Medicare & Medicaid Services (CMS) recently issued guidance announcing that
it is prioritizing and suspending non-emergency federal and State Survey Agency surveys to
allow surveyors and facilities to focus on protecting individuals from the spread of infectious
disease, including the recent spread of COVID-19. 1 Consistent with that action, CMS is
reprioritizing the audit activity discussed below for Medicare Advantage organizations, Part D
sponsors, Medicare-Medicaid Plans, and PACE organizations in order to allow CMS and these
organizations to focus on the health and safety threats currently faced by enrollees, participants,
and other impacted individuals.

Medicare Parts C and D and PACE Program Audits
CMS is reprioritizing its scheduled program audits for Medicare Advantage organizations, Part
D sponsors, Medicare-Medicaid Plans, and PACE organizations until further notice. 2 CMS will
continue its oversight of these organizations, but will temporarily shift our oversight activities
from conducting routine audit activities to prioritizing the investigation and resolution of:
   • Instances of noncompliance where the health and/or safety of beneficiaries are at serious
       risk (for example, lack of access to critically needed health services or prescription
       drugs); and
   • Complaints alleging infection control concerns, including COVID-19 or other respiratory
       illnesses.




1
    https://www.cms.gov/medicare/quality-safety-oversight-general-information/coronavirus
2
    Audits conducted pursuant to 42 CFR §§ 422.503(d)(2), 423.504(d)(2), 460.190, and 460.192.
Contract-Level RADV Audits
CMS is suspending RADV activities related to the payment year 2015 audit and will not initiate
any additional contract-level audits until after the public health emergency has ended.
Organizations should immediately suspend soliciting RADV-related medical records from
providers.

An organization may submit to CMS any medical record documentation that has already been
obtained from providers. The Central Data Abstraction Tool (CDAT) will remain open for that
purpose. The RADV mailbox and CDAT help desk will also remain open.

CMS will continue reviewing medical records that have been submitted, including submissions
for the 2014 audit, and providing feedback to organizations though CDAT.

Effective Date: Immediately. The suspension of the audit activities mentioned in this
memorandum will be time-limited. CMS will make an announcement when normal audit
activities are resumed after the public health emergency has ended.

Questions
• Questions related to contract-level RADV audits should be sent to RADV@cms.hhs.gov
• PACE organizations may send PACE audit questions to PACEAuditQs@cms.hhs.gov
• All other organization types may send program audit questions to
   Part_c_part_d_audit@cms.hhs.gov




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