CMS-10717 Pre Audit Issue Summary

Medicare Part C and Part D Program Audit and Industry-Wide Part C Timeliness Monitoring Project (TMP) Protocols (CMS-10717)

PreAuditIssueSummary

Program Audits

OMB: 0938-1395

Document [pdf]
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Instructions: Provide a list of all disclosed issues of noncompliance that are relevant to the program areas and scope of universe being audited. A disclosed issue is one that has been reported to CMS prior to the date of the audit engagement letter. Issues identified by CMS through on-going monitoring or other account management/oversight activities during the plan year are not considered disclosed. This template is due within 5 business days after the
receipt of the engagement letter. Please upload this completed spreadsheet to the HPMS Audit Module as follows: Data Upload tab, Level Association "Audit", File Type "Supplemental File", document name "Pre-audit Issue Summary".
Issue
number

Program Area
Impacted

Description of the issue
(explain what happened)

Root cause analysis of the issue
(explain why it happened)

# of enrollees
impacted

Date issue identified
Submit in CCYY/MM/DD
format (e.g., 2020/01/01)

Date issue disclosed to CMS
Submit in CCYY/MM/DD
format (e.g., 2020/01/01)

To whom the issue was
disclosed
(first and last name)

Was the issue fully
remediated in the
Sponsoring
organization's system
and for enrollees?
Y/N

Description of system/operational
remediation

Date
system/operational
remediation initiated
Submit in
CCYY/MM/DD
format
(e.g., 2020/01/01)

Date
system/operational
remediation completed
Submit in
CCYY/MM/DD
format
(e.g., 2020/01/01)

Description of remediation for negatively
impacted enrollees

Date enrollee
outreach and
remediation initiated
Submit in
CCYY/MM/DD
format (e.g.,
2020/01/01)

Date enrollee outreach
and remediation
completed
Submit in
CCYY/MM/DD format
(e.g., 2020/01/01)

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information collection is estimated to average 701 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to:
CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850. ****CMS Disclosure**** Please do not send applications, claims, payments, medical records or any documents containing sensitive information to the PRA Reports Clearance Office. Please note that any correspondence
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OMB Approval 0938-1395 (Expires 05/31/2024)


File Typeapplication/pdf
File TitlePre-Audit Issue Summary
SubjectPAIS; Program Audits
AuthorCMS
File Modified2023-04-07
File Created2023-04-07

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