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Effective January 1, 2015, the Centers for Medicare &
Medicaid Services (CMS) will revise contractual regulations
42 CFR ?? 422.504(i)(2)(i) and 423.505(i)(2)(i) to make clear that CMS and its
designees may ?collect? records, in
addition to their existing authority to ?audit, evaluate, and inspect?
information, from First-Tier, Downstream, and
Other Related Entities (FDR).
In accordance with these changes, the Medicare Advantage Addendum will be
amended to read as follows:
Inspection and Audit.
Contractor shall permit CMS, the Department of Health and Human Services (HHS),
the Comptroller General, or their designees to audit, evaluate,
collect, and inspect any books, contracts,
computer, or other electronic systems, including medical records and
documentation of the FDRs related to
CMS?s contract with the Medicare Advantage organization as it pertains to any
Services provided under the
Agreement. CMS, HHS, the Comptroller General, or their designees have the right
to audit, evaluate, collect,
and inspect any records directly from any FDRs. This right to audit, evaluate,
collect, and inspect shall extend
ten (10) years from the expiration or termination of the Agreement or
completion of final audit, whichever is later,
unless otherwise required by applicable Law.
Please note, this is for informational purposes only and does not require
any action on your part at this time.
Updates to the Medicare Advantage Addendum will take place upon contract
renewal.
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