AUDIT METHODOLOGIES 4
TheCenters forMedicare and Medicaid services (CMS) has an objective of ensuringthat patients to get access to high-qualityhealthcare services at an affordable price. CMS attains theaforementioned goal through Children’s Health Insurance Program,Medicaid, Health Insurance Marketplace, and Medicare. As aconsequence of the increased need to evaluate the efficiency of itsservices, CMS uses various interventions to audit all processesconfined within the scope of medical care delivery. Accordingly, theessay discusses plan program audit as one of the methodologiesadopted by CMS to evaluate its services.
Planprogram audit approach is geared towards enhancing the delivery ofhealthcare services in accordance with the objectives of Medicaid.Plan audit methodology is composed of four phases namely validation,engagement and universe submission, fieldwork, and reporting. Theentire audit process takes an approximate of twenty-twoto forty-eightweeks, with a significant amount of this time being dedicated to thevalidation and closing out phase ("Program Audits ").Fieldwork phase is the most important stage in this methodology sinceit enables CMS to acquire first-handdata from the selected sample.
Theplan program approach is relatively effective since,through it, CMS designs and implements policies based on evidence.However, there are some sections of the tool that needs improvement.First, the audit intervention should consider increasing the timededicated to field work (investigations) from the current seven weeksto at least ten works ("Program Audits "). The period willenable the healthcare practitionersand all the stakeholders in the industry to ascertain factors thatinhibit CSM from achieving the set goals and thus, inform on the bestcourse of action.
Inconclusion, plan program audit intervention is among the majorinterventions adopted by CMS to audit the quality of its services.The methodology is divided into four phases that require overtwenty-twoweeks to accomplish. Plan program tool is relatively effective butcan be enhanced through increasing the time dedicated to thefieldwork phase.
ProgramAudits – Centers for Medicare & Medicaid Services.(2017). Cms.gov.Retrieved 12 April 2017, fromhttps://www.cms.gov/Medicare/Compliance-and-Audits/Part-C-and-Part-D-Compliance-and-Audits/ProgramAudits.html
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