Medicare Independent Audit Validation

MetaStar’s Medicare Independent Audit Validation service supports Medicare Advantage Organizations (MAOs), Prescription Drug Plans (PDPs), Medicare-Medicaid Plans (MMPs), and Cost Plans required by the Centers for Medicare & Medicaid Services (CMS) to undergo an Independent Validation Audit following their CMS Program Audit.

When you receive a final audit report identifying noncompliance, CMS often mandates that you retain an Independent Auditor. MetaStar fills this role to validate corrective actions and confirm identified conditions are remediated.

Complete and CMS-Compliant Medicare Independent Audit Validation

MetaStar provides a full-scope, CMS-compliant Independent Audit service that is accurate and efficient. Our process adheres to all CMS protocols, timelines, and documentation standards. 

Our Medicare Independent Audit Validation Services

• Independent Validation Audit Execution
  We conduct comprehensive validation audits in accordance with CMS protocols, templates, and timelines. Our team objectively evaluates each cited condition.
• Audit Work Plan Development and CMS Submission
  MetaStar prepares a customized, CMS-compliant Independent Validation Audit Work Plan based on your audit findings. We also manage the CMS review and approval process.
• Universe Integrity Testing and Sampling
  Our auditors perform universe data integrity testing, transaction sampling, and record evaluation, aligned with CMS minimum sample size and methodology requirements.
• Compliance-Focused Transaction Testing
  MetaStar validates remediation by testing live cases and outcomes, confirming that corrective actions restored full compliance—not just that corrective processes were implemented.
• Impact Analysis Review (as needed)
  If new or recurring noncompliance is identified, MetaStar evaluates the root cause and assists you with quantifying the scope for CMS reporting.
• Validation Audit Reporting
  We prepare and submit a detailed Validation Audit Report, adhering to CMS guidelines. Our report supports CMS’s determination to close your audit file.

Why MetaStar

• Independent and Conflict-Free
  MetaStar meets CMS’s conflict-of-interest standards, with no involvement in your corrective action development or implementation.
• Audit Expertise
  We have deep experience in Medicare Part C, Part D, and MMP audit protocols, including compliance, benefit administration, coverage determinations, appeals, grievances, and care coordination.
• Clinical and Technical Rigor
  MetaStar’s multi-disciplinary audit teams include licensed pharmacists, physicians, and registered nurses where clinical expertise is required.
• CMS Alignment
  Our process mirrors CMS’s own fieldwork, universe structure, and validation expectations, ensuring Sponsors are fully prepared for CMS review.
• Efficient Turnaround
  Our validated work plans, transaction testing, and reporting are designed to meet the strict 180-day CMS validation audit window with minimal operational disruption.

Optimize Your CMS Audit Outcome with MetaStar

Partner with MetaStar to streamline your Medicare Independent Audit Validation. Our proven, CMS-aligned process ensures that your organization meets regulatory expectations while maintaining operational continuity.