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The Centers for Medicare and Medicaid services (CMS) has an objective of ensuring that patients to get access to high-quality healthcare services at an affordable price. CMS attains the aforementioned goal through Children’s Health Insurance Program, Medicaid, Health Insurance Marketplace, and Medicare. As a consequence of the increased need to evaluate the efficiency of its services, CMS uses various interventions to audit all processes confined within the scope of medical care delivery. Accordingly, the essay discusses plan program audit as one of the methodologies adopted by CMS to evaluate its services.
Plan program audit approach is geared towards enhancing the delivery of healthcare 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. The entire audit process takes an approximate of twenty-two to forty-eight weeks, with a significant amount of this time being dedicated to the validation and closing out phase (“Program Audits “). Fieldwork phase is the most important stage in this methodology since it enables CMS to acquire first-hand data from the selected sample.
The plan 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 time dedicated to field work (investigations) from the current seven weeks to at least ten works (“Program Audits “). The period will enable the healthcare practitioners and all the stakeholders in the industry to ascertain factors that inhibit CSM from achieving the set goals and thus, inform on the best course of action.
In conclusion, plan program audit intervention is among the major interventions adopted by CMS to audit the quality of its services. The methodology is divided into four phases that require over twenty-two weeks to accomplish. Plan program tool is relatively effective but can be enhanced through increasing the time dedicated to the fieldwork phase.
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