Uncertainties Abound as MAOs Prep for 2020 Program Audits

After providing a break to Medicare Advantage and Part D plans dealing with the COVID-19 pandemic by suspending audit and quality reporting activities, CMS appears to be hitting the restart button on 2020 program audits and risk adjustment data validation (RADV) audits. But with only five full months left in the calendar year, health plans and compliance experts are wondering how thoroughly CMS will conduct the annual program audit process, which focuses on a subset of MAOs that varies in size depending on the year.

Nevertheless, experts say clients should have been preparing for 2020 audits based on the draft protocols CMS released prior to the pandemic and just finalized with a few tweaks. At the same time, they must consider proposed changes for 2021 that were recently posted with a comment period.

© 2022 MMIT
Lauren Flynn Kelly

Lauren Flynn Kelly Managing Editor, Radar on Medicare Advantage

Lauren has been covering health business issues, including drug benefits and specialty pharmacy, for more than a decade. She served as editor of Drug Benefit News (the predecessor to Radar on Drug Benefits) from 2004 to 2005 and again from 2011 to 2016, and now manages Radar on Medicare Advantage. Lauren graduated from Vassar College with a B.A. in English.

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