The 5 pillars of a continuous audit readiness framework for health plans
A continuous audit readiness framework is not a technology purchase, a new team structure, or an expanded budget. It is […]
Audit Readiness
Mock audits for health plans: why once a year is not enough
A mock audit for a health plan should work as a diagnostic tool — not a final exam. Yet in
Why CMS program audit readiness breaks — even when your team is good
CMS program audit readiness fails in most health plans for the same structural reason. It is not built as an
Why CMS audits are designed to test operations, not just documentation
For years, health plans treated CMS audits as documentation exercises. If policies looked current, files appeared complete, and evidence arrived
2026 CMS Program Audit Update: What Plans Must Do To Align
What Changed for 2026: Key Updates from CMS The 2026 audit update from CMS brings a fundamental shift in audit
2026 CMS Program Audit Countdown: How Health Plans Can Prepare Now
The audit clock has already started CMS Program Audits follow predictable patterns, but most health plans still treat them as
Internal Audit: Why Health Plans Can’t Rely on Generic Internal Audit Tools
Why most internal audit tools don’t work as expected for health plans Every year, CMS program audits trigger millions in
The 2025–2026 CMS Program Audit Calendar for Health Plans: Key Deadlines and How to Prepare
The CMS Program Audit Calendar for Health Plans is more than a timeline; it’s a test of preparedness. CMS Program
CMS Audit Updates 2025: What Medicare Advantage Plans Need to Know
CMS has introduced key RADV audit updates that raise the bar for health plan accountability. This blog breaks down what payers need to know, including changes to sampling, extrapolation, and error rate calculations, and how to stay audit-ready. Learn how automation, data quality, and GenAI can help reduce risk and improve compliance with the new CMS RADV audit requirements.
CMS 2025 Update: Medicare Part C & D Reporting Guide for Health Plans
Every year, the Centers for Medicare & Medicaid Services (CMS) requires Medicare Advantage Organizations (MAOs) and Prescription Drug Plans (PDP)