What are audit protocols?

Audit protocols assist the regulated community in developing programs at individual facilities to evaluate their compliance with environmental requirements under federal law. The protocols are intended solely as guidance in this effort.

What are CMS audits?

These program audits measure a Sponsoring organization’s compliance with the terms of its contract with CMS, in particular, the requirements associated with access to medical services, drugs, and other enrollee protections required by Medicare.

What is CMS compliance?

The CMS National Standards Group, on behalf of HHS, administers the Compliance Review Program to ensure compliance among covered entities with HIPAA Administrative Simplification rules for electronic health care transactions.

What is a CMS mock audit?

A mock program audit helps plans prepare for an actual CMS audit by: Identifying resources. Uncovering gaps in processes. Enhancing communication with first tier, downstream and related entities (FDRs) Including evaluating their ability to assist in audit activities, such as compiling universes.

What is the OCR audit protocol?

What is the OCR HIPAA Audit Program? The OCR HIPAA Audit program is designed to analyze processes, controls, and policies of selected covered entities and business associates. The OCR has established a comprehensive audit protocol that contains the requirements to be assessed through these performance audits.

What is a CMS data validation audit?

Medicare Part C & D Validation Audits (DVA) are designed to confirm the accuracy and completeness of reported results used in decision making or performance reporting.

What triggers a Medicare audit?

What Triggers a Medicare Audit? A key factor that often triggers an audit is claiming reimbursement for a higher than usual frequency of services over a period of time compared to other health professionals who provide similar services.