Steps for Successfully Completing a CPC Audit

January 30, 2018

Written by Kristen Schuster, Practice Facilitator

What can you expect if your practice is selected for a program audit? First, don’t panic. Second, plan for when an audit happens, not if an audit happens. This blog will walk you through how the audit process works and provide helpful tips to successfully pass a program audit.

If your CPC+ practice is chosen for you an audit you will receive notification with the auditor’s contact information. You may contact the auditor at any time with questions. After an audit notification you will be invited to participate in a web-based training that will guide you through the audit process, timelines and logistics. You will also receive an audit checklist to track deliverables and due dates.

CPC+ audits will be conducted off-site. If selected for an audit, you will be required to complete a questionnaire and provide supporting documentation related to CPC+ practice reporting and other program requirements. You may also be asked for a walk-through of your electronic health record and interviews with staff members may also be requested. Below are suggested documents that will make the audit process smooth for your practice. Remember: CPC+ records need to be maintained for 10 years according to the Participation Agreement and the CPC+ Implementation Guide.

Financial Documentation

Retain documentation to support your spending of CMF and CPCP payments paid to you by Medicare and payer partners (e.g., receipts, invoices, paystubs, W-2s, cancelled checks, contracts), including documentation of the approach used to assign overhead costs to CPC+.
Record CPC+ revenue and expenses separately in your practice’s accounting system.
If you are part of a larger system, ensure CPC+ revenue and expenses are accounted separately and at the practice level.
Consider automating your accounting processes.

Care Delivery Documentation

Signed collaborative care agreements
Patient family advisory council meeting minutes
Data reports used to report empanelment, risk stratification and care management
eCQM reports used for attestation in the CMS Portal
QRDA III reports used to submit eCQM data to the QPP website

As always, complete CPC+ information from CMS can be found on the CPC+ Connect Portal. We encourage you to access the portal and check out all available CMS CPC+ resources.
If you have any questions, or run into issues with any of the CPC+ objectives and would like help, please use the “Leave a Reply” section below, or email Kristen Schuster directly with your questions or comments.

Other Resource Links
CMS Implementation Guide
See all CPC+ Blog Posts

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