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Medicare-Medicaid Plan (MMP) Audit Programs

SPOTLIGHT & RELEASES

02/2019 - CMS Program Audit Frequently Asked Questions (FAQs) (02/2019)


CMS conducts program audits of MMPs, Medicare Advantage Organizations, and Prescription Drug Plans, collectively referred to as "sponsors". CMS Medicare Advantage Parts C and D program audits for sponsors that include and 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. MMP Care Coordination & Quality Improvement Program Effectiveness (MMP-CCQIPE) Program Area
  2. MMP Service Authorization Requests, Appeals and Grievances (SARAG) Program Area

More information on audit programs is available below:


Related Links

CM Part C and Part D Program Audits