Medicare-Medicaid Plan (MMP) Audit Programs

SPOTLIGHT & RELEASES

04/06/2022: CMS released a revised version of the 2022 MMPCC Supplemental Questionnaire. More information can be found below.

 

General Information

CMS conducts program audits of MMPs, Medicare Advantage Organizations (MAOs), and Prescription Drug Plans (PDPs), collectively referred to as "sponsors" to help drive the industry towards improvements in the delivery of health care services. CMS Medicare Advantage Parts C and D program audits for sponsors that include an MMP utilize the Center for Medicare Program Audit Protocols as well as two MMP-specific protocols designed to ensure compliance with three-way contract requirements in the following areas:

  1. Medicare-Medicaid Plan Care Coordination (MMPCC) &/OR MMP Care Coordination & Quality Improvement Program Effectiveness (MMP-CCQIPE) Program Area
  2. MMP Service Authorization Requests, Appeals and Grievances (SARAG) Program Area

 

Audit Protocols

 

More information about the Program Audit Process, Protocols, and Enforcement can be found on the CM Part C and Part D Program Audits page. Specific questions on Program Audits may be submitted to the Part C and D Audits mailbox. Specific questions on MMP audits may be submitted to the MMCO mailbox.


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Page Last Modified:
04/06/2022 12:49 PM