What is one of the primary differences between a review and an audit under CMS Program Integrity?

• A. Audits occur every 30 days
• B. Only contractors perform audits
• C. Audits are methodological in their approach
• D. There is no difference

Answer: (C)

The primary difference between a review and an audit under CMS Program Integrity is that audits are methodological in their approach. This means that audits follow a systematic, organized, and structured process to evaluate compliance and identify discrepancies or areas for improvement. Auditors utilize specific protocols and standard practices to gather data, analyze it, and produce findings.

This methodological nature of audits allows for a more comprehensive examination of practices and policies. It ensures that the audit is thorough and that all aspects of compliance are evaluated accurately and consistently. Additionally, the findings from an audit are typically more formal and may have different implications, such as formal reporting, required corrective actions, or potential penalties, depending on the results.

In contrast, reviews may not always follow such rigid methodologies and can be more informal or focused on specific issues rather than a comprehensive evaluation. Understanding this distinction is essential for grasping the broader scope and purpose of each process under CMS Program Integrity.