MEDICARE Part C and D DATA VALIDATION Audits
The Medicare Part C and D Data Validation Audits (DVA) are regulations (42 CFR 422,516, 422.514, CMS-4085-F) implemented by the Centers for Medicare and Medicare (CMS).
These regulations requires Medicare Advantage Organization (MAO) and Part D sponsors to contract with independent external data validation auditors to review the process and data that is reported to CMS. Aqurate has developed a Medicare Part C and Part D data Validation Audit program that incorporates its extensive experience.
Aqurate DVA team has:
1. Extensive experience in conducting Part C and D data validation audits since the inception of the program.
2. Thorough understanding of Part C and Part D reporting requirements and technical specifications.
3. Experience in conducting internal audits for various business operations including functions related to Medicare enrollment/disenrollment, grievance and appeals, pharmacy processes, etc.,
4. Extensive experience in reviewing systems and processes, including systems for claims, enrollment, provider data, pharmacy data, behavioral health, etc. as a component of HEDIS® compliance audits, which are similar to Part C and Part D validation audits. Both type of audits included evaluation of performance reporting and evaluation of systems’ ability to collect, store, compile and report.
5. Over 25 years of experience with source code review, which includes developing and reviewing complex source code for performance reporting for Medicare, Medicaid and commercial Managed Care Organizations.
6. Thorough familiarity with various software programs and query languages including, SQL, SAS, Brio, Crystal reports, Cognos, MS Access, Excel, etc.
7. Experience in statistical analysis.
Aqurate assigns its audit team members based on specific needs of the MAO/Part D sponsor. The MAO/Part D sponsor’s systems, reporting requirements and other audit needs are matched with auditor experience and expertise. In addition to the above stated experience, our audit team is a subject matter expert (SME) related to areas concerning Title I and II of the Medicare Modernization Act (MMA), Medicare Part C and Part D regulations Medicare Managed Care Manual and Prescription Drug Benefit Manual.
To learn more about Aqurate Health Data Management’s services, or to request a proposal please Contact Us