Medicare Part C and D Data Validation Audits (DVA) are required by the regulations (42 CFR 422,516, 422.514, CMS-4085-F) implemented by the Centers for Medicare and Medicare Services (CMS). In order to ensure the independence of the Data Validation Audit, organizations cannot use their own staff to conduct it. Instead, Medicare Advantage Organizations (MAO) and Part D sponsors are required to contract with independent external data validation auditors to review the process and data that is reported to CMS.
Madena is pleased to offer a Medicare Part C and Part D Data Validation Contractor Audit program that incorporates our extensive industry experience.
In addition, all Health Plan data is housed in SSAE-16 and HITRUST certified servers, which demonstrates a high level of compliance with HIPAA and the HITECH Act. Madena continually updates the staff training for HIPAA Compliance and has active monitoring tools in place.
Madena has been dedicated to auditing and consulting with managed care organizations and pharmacy benefit managers for over eight years. We have worked with clients of all sizes, from new start-ups to some of the largest Medicare managed care organizations in the country.
A core audit team is assigned to each data validation audit to serve as the primary reviewer. Additional Madena staff resources for source code review and census/sample validation will be included in the audit review team. Access to greater staff expertise allows for efficient completion of documentation review and responses to your communications throughout the process.
Madena is committed to involving clients throughout the process and keeping them informed of any possible findings. Madena will share a regular issue log, timeline, and status of key deliverables to help clients manage expectations as well as highlight any concerns about documentation submitted and reviewed. There will be no surprises on the final report. Madena conducts your Data Validation review in an open, efficient, and reassuring manner.
by Sue Dahlkamp, Interim Compliance Officer and Director, Operations