What is a CMS program audit? Centers for Medicare and Medicaid Services (CMS)

 

What is a CMS program audit? Centers for Medicare and Medicaid Services (CMS)

Per the current CMS Program Audit Process Overview published by the Medicare Parts C and D Oversight and Enforcement Group Division of Audit Operations, the purpose of a Tracer is to allow the organization (Sponsor) to present any information they choose to explain the case selected by the CMS Auditors.

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. 

In the guidelines, CMS recommends information it expects to see in a Tracer, but CMS doesn’t prohibit the Sponsor from adding information to help the Auditors understand the Sponsor’s processes and successes. CMS is very generous in the time it gives to a Sponsor to present Tracers.