CMS-10630 Audit Survey

Programs of All-Inclusive Care for
the Elderly (PACE)
Audit Survey

Pre-Audit Activities
1. How easy was it to follow CMS’ documentation and universe submission instructions?
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Not Easy

Easy

Very Easy

2. Did the Audit Lead conduct a follow-up call after the Audit Engagement letter was issued?

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Yes
No

3. Was the Audit Lead available to answer questions prior to the audit?
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Not Available

Available

Always Available

4. How helpful was the Audit Lead in assisting your organization with pre-audit processes such as
documentation submission and universe preparation?
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Not Helpful

Helpful

Very Helpful

5. How many hours do you estimate staff spent collecting, reviewing, and submitting data prior to the
audit?

6. Was the timeframe for submitting documentation and data during the pre-audit portion of the audit
adequate?
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Not Adequate

Adequate

Very Adequate

7. Do you have any additional comments or suggestions regarding the pre-audit process:

Audit Activities
1. Did the Audit Lead conduct an Entrance Conference?

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Yes
No

2. When the audit team determined that sample cases were potentially non-compliant, did members of the
audit team explain why the sample cases were non-compliant? Enter NA if there was no non-compliance
identified for a particular element.
SDAG:
NA

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Never

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Always

Provision of Services:
NA

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Never

Sometimes

Always

Personnel:
NA

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Never

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Always

Quality:
NA

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Never

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Always

3. Did the audit team members provide the PACE organization (PO) with opportunities to provide additional
supporting documentation when potential non-compliance was identified? Enter NA if there was no noncompliance identified for a particular element.
SDAG:
NA

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Never

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Always

Provision of Services:
NA

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Never

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Always

Personnel:
NA

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Never

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Always

Quality:
NA

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Never

Sometimes

Always

4. Did the audit team members request one or more Root Cause Analyses? If so, how well did the auditor(s)
explain the purpose of the RCA(s) and how to complete them? Enter NA if no RCAs were requested for a
particular element.
SDAG:
NA

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Needs Improvement

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Explained Adequately

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Explained Very Well

Provision of Services:
NA

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Needs Improvement

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Explained Adequately

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Explained Very Well

Personnel:
NA

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Needs Improvement

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Explained Adequately

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Explained Very Well

Quality:
NA

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Needs Improvement

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Explained Adequately

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Explained Very Well

5. Did the audit team members request one or more Impact Analyses? If so, how well did the auditor(s)
explain the purpose of the Impact Analyses and how to complete them? Enter NA if there no Impact
Analyses were requested for a particular element.
SDAG:
NA

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Needs Improvement

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Explained Adequately

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Explained Very Well

Provision of Services:
NA

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Needs Improvement

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Explained Adequately

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Explained Very Well

Personnel:
NA

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Needs Improvement

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Explained Adequately

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Explained Very Well

Quality:
NA

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Needs Improvement

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Explained Adequately

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Explained Very Well

6. Was 10 business days a reasonable timeframe for completing the requested Impact Analyses? Enter
NA if you did not complete an Impact Analysis.
NA

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Not Reasonable

Somewhat Reasonable

Very Reasonable

7. In order to complete the requested Impact Analyses:
a. How many hours do you estimate it took to complete the requested Impact Analyses?

b. How may staff members do you estimate it took to complete the requested Impact Analyses?

8. During the exit conference, was your organization familiar with the conditions being cited and why
they were being cited?

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Yes
No
If you responded No, which conditions were not discussed prior to the exit conference (you may enter the
condition number cited in your audit report or provide a brief description of the condition)?

9. How many hours do you estimate staff spent collecting, reviewing, and submitting data during the
audit?

10. Was the timeframe for submitting documentation and data during the audit adequate?
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Not Adequate

Adequate

Very Adequate

11. Do you have any additional comments or suggestions regarding the audit fieldwork process:

Post-Audit Activities
1. Did the Audit Lead contact the PACE organization before issuing an Immediate Corrective Action
Required (ICAR) notification or the Draft Report (if no ICARs were cited) to discuss any conditions
that were added or removed following the exit conference?

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Yes
No
NA – No conditions were added or removed.

2. How easy was it to understand the Draft and Final Audit Reports?
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Not Easy

Easy

Very Easy

3. How helpful was the Audit Lead when responding to corrective action plan (CAP) questions? Enter
NA if you did not have any CAPs or did not ask for assistance.
NA

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Not Helpful

Helpful

Very Helpful

4. How helpful was the Account Manager when responding to CAP monitoring questions? Enter NA if
you did not have any CAPs or did not ask for assistance.
NA

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Not Helpful

Helpful

Very Helpful

5. How many hours do you estimate staff spent collecting, reviewing, and submitting data following
the audit?

6. Was the timeframe for submitting documentation and data following the audit adequate?
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Not Adequate

Adequate

Very Adequate

7. Do you have any additional comments or suggestions regarding the post-audit process:

General Audit Questions
1. Please identify any areas or aspects of the audit process that you believe would benefit from
increased transparency or communication.

2. Does the PO’s parent organization operate any additional PACE organizations and/or PACE
contracts?

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Yes
No

If yes, please enter the names and contract numbers of the other PACE organizations.
PACE Organization
Names/Contract Numbers:

3. How would you compare the audit of your PACE organization with the audits of other POs operated
by the same parent organization? Enter NA if the PO’s parent organization does not operate any
other PACE organizations or if the PACE contracts do not compare audit experiences.
NA

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Very Different

Similar

Very Similar

4. If you feel that your audit experience was different than other PACE organizations operated by the
same parent organization, please explain how they were different:

5. If you feel that your audit experience was different than other PACE organizations operated by
different parent organizations, please explain how they were different:

6. Are there any other ways you believe we can improve the overall audit process?