Qualifications

80.1 – Qualifications (Rev. 127, Issued: 07-13-07, Effective: 10-01-07, Implementation: 10-01-07) The first general standard for government auditing is: "The staff assigned to conduct the audit should collectively possess adequate professional proficiency for the tasks required." Ensure that the Medicare audit is conducted by staff that collectively has the knowledge and skills necessary for the audit. These qualifications apply to the knowledge and skills of the contractor’s organization as a whole, and not necessarily to every individual auditor. A – Continuing Education and Training (CET) To meet this standard, the contractor shall establish a program to ensure that its staff maintains professional proficiency through CET. The following represent the continuing education responsibilities of an audit organization and also reflect additional guidance from CMS to help the contractor. B – Education Required All persons responsible for planning, directing, conducting, reviewing, or reporting on government audits must receive at least 80 hours of continuing education and training (CET) every two years. For example, auditors who first start conducting audits on January 1, 2002, must complete the CET requirements as follows: • The first 80 hours must be completed by December 31, 2003. Any excess over the 80-hour requirement does not carry forward to the next two-year cycle. • After CET requirements for the first two-year period (i.e., January 1, 2002, to December 31, 2003) have been satisfied, a rolling count is permissible for measuring compliance with the requirements. Under a rolling count, compliance with the CET requirements is measured annually using the two most recent years. • At least 20 hours must be completed in each year of the two-year cycle. • At least 24 of the 80 hours must be in subjects directly related to government environment and to government auditing. Since the contractor is operating in a specific or unique environment, i.e., Medicare, it shall schedule the 24 hours of training, noted above, in subjects related to the government environment and to the Medicare auditing process. • Appropriate courses on Medicare and other health care related issues include, but are not limited to, GAS, Medicare policy development (how it affects audits), preparation and review of Medicare audit working papers, current Medicare audit and payment issues, and the AICPA Audit and Accounting Guide: Providers of Health Care Services. For purposes of the 80-hour and the 24-hour requirements, CMS interprets the term "conducting" and the phrase "conducting substantial portions of the field work" as referring to those individuals who perform substantial portions of the tests and procedures necessary to accomplish the audit objectives. An individual is considered to be responsible for "conducting substantial portions of the field work," for purposes of the CET requirements, when the following conditions are met: • On a given audit, the individual performs 20 percent or more of the total field work; or • In a given year, the individual's chargeable time to government audits is 20 percent or more of the individual's total chargeable time. Staffs who are only involved in performing audit work but not involved in planning, directing, or reporting on the audit or attestation engagement and who charges less than 20 percent of their time to the, desk review, audit and attestation engagement are required to take 24 hours of government related. CET in each 2 year period. However, they are not required to comply with the 80-hour CET requirement. Auditors who have been employed by the audit organization for less than one year of a given two-year period are not required to complete a minimum number of CET hours. However, entry-level auditors with less than one year with the audit organization must receive appropriate training during their first year with the audit organization. Auditors employed by the audit organization for one year, but less than two years, in a given two- year period, must complete a minimum of 20 hours of CET in the full calendar year. All auditors to whom the CET requirements for 80 hours and 24 hours apply have two years to meet the requirements. Terminated employees must have been trained in accordance with the contractor’s plan of training, at least until a formal notice of termination is received or issued. Auditors who have not completed the required number of CET hours for any two-year period for a legitimate reason will have the two months immediately following the two- year period to make up the deficiency. Auditors must make up any deficiency in the 24- hour requirement first. The contractor shall not count any CET hours completed towards a deficiency toward either the 20-hour requirement in the year in which they are taken, or the 80-hour and the 24-hour requirements for the two-year period in which they are taken. C – Employees Covered Under the CET Requirement Any auditor who is responsible for planning, directing, conducting, reviewing, or reporting on government audits is subject to the CET requirements. Also, anyone whose decisions affect the outcome of government audits is covered by CET requirements. Since the contractor may use various types of employees in the audit process, the following is CMS's interpretation of the applicability of CET requirements to certain types of employees: • Junior Auditors – CET requirements extend to junior auditors who perform portions of the audit. "Conducting" is not limited to auditors in a supervisory or management role. • Contract Auditors –When the contractor contracts with CPA firms for entire audits, or to provide audit staff to work under its supervision, they are subject to the same requirements as the contractor. The contractor shall require compliance with the CET requirements as a specific condition of the audit subcontract. It shall obtain written assurance that each person meets CET requirements prior to the start of each audit. • Temporary Auditing Staff – A temporary auditor who is hired for a very limited timeframe, not to exceed one quarter at a time or in one year, under the contractor’s direct supervision, is not subject to CET requirements. • Crossover Staff – Staff members used in multiple functions must meet the CET requirements when their decisions could affect the outcome of an audit. For CET purposes employees who are transferred to the Medicare audit department are considered new hires, as are employees who are promoted to a professional staff level. • External Consultants and Internal Consultants and Specialists – External consultants and internal consultants and specialists must be qualified and must maintain their professional proficiency in their area of expertise and specialization, but they are not required to meet CET requirements. For example, attorneys the contractor employs, who work in the provider appeals area, are not subject to the CET requirements, but they must maintain their professional proficiency. • Clerical and Paraprofessional Staff – Clerical and paraprofessional staff, including student interns, are not subject to the CET requirements. Review all position descriptions to ensure that they accurately reflect the employees' duties and responsibilities. If you have concerns or questions on certain position descriptions, submit your questions to your RO for a determination. These position descriptions will be reviewed by CMS and the Office of the Inspector General (OIG) to determine the need for compliance with the CET requirements. D – Contractor Responsibility Establish and implement a program to ensure that the auditors meet the CET requirements. You must: y Prepare a general plan for training. Review and revise the plan, as appropriate, and allocate resources to ensure that all staff subject to CET requirements receive training; and y Implement the CET program to ensure that for every two-year period the 80-hour and 24-hour requirements are met, and that at least 20 CET hours are completed in each year of the two-year period. y Retain course information for your employees receiving CET credit for contractor- sponsored courses. Maintain records for a five-year period from the completion of the two-year period. Maintain a record for each employee which reflects: − Record of participation; − Course agenda; − Course date(s); − Location at which the course was given; − Name(s) of instructor(s) and related training, education, and experience; − Number of CET credit hours; and − Copy of course material presented. y Retain course information for employees receiving CET credit for outside courses. Maintain records for a five-year period from the completion of the two-year period. Obtain a letter of completion or certificate, and retain a record for each employee which reflects: − Name of course; − Course date(s); − Location at which the course was given; − Course sponsor; and − Number of CET credit hours. y Submit, to the appropriate RO, an annual certification by January 31 following the close of any calendar year, stating that it is complying with the CET requirements. E – General Guidelines for Training Courses Continuing education and training may include such topics as current developments in audit methodology, accounting, assessment of internal controls, principles of management and supervision, financial management, statistical sampling, evaluation design, and data analysis. It also includes subjects related to the auditors' specific field of work. The contractor shall consider the following sources when developing a training program for auditors: • Recognition for Courses Needed for CPA Licensing – In meeting the overall 80- hour requirement, courses approved or recognized by the AICPA or the respective state licensing board that contribute to the auditors' professional proficiency are recognized for purposes of meeting the CET requirements. • CMS-Sponsored Training – From time to time, CMS may contract with vendors to provide training courses and will notify you of their availability. In addition, CMS may offer training in settings such as a national audit conference. • Contractor-Sponsored Training – The contractor should obtain sponsorship status for its training courses through its respective state CPA licensing board. This will help to ensure that the courses will meet the CET requirements. Also, the courses will be recognized for CPAs on your staff that is required to obtain continuing professional education credits for CPA licensure. In the development of in-house training, the contractor shall consider the AICPA's Statement of Standards for Formal Group and Formal Self-Study Programs. While in-house training is recognized as the most cost-efficient method of training, the contractor should not rely solely on this method. • Credit Hours – A CET credit hour may be given for each 50 minutes of participation in programs and activities that qualify. One-half CET hour increments (equal to 25 minutes) may also be given after the first CET hour has been earned in a given program or activity. For example, two 90-minute, two 50- minute, and three 40-minute presentations equal 400 minutes or 8 CET hours. When the total minutes of a presentation are more than 50, but not equally divisible by 50, the CET hours should be rounded down to the nearest one-half hour. A conference in which individual segments may be less than 50 minutes is counted as one program, rather than several short programs. The total minutes of all segments will be divided by 50 minutes in order to determine the CET hours for the program. For a college or university course, each unit of credit earned on a semester system will equal 15 CET hours. Each unit of credit earned on a quarterly system will equal 10 CET hours. • Credit for Instructor Preparation Time – When an instructor or discussion leader serves at a program for which participants receive CET credit, and is at a level that increases professional competence, the contractor shall give CET credit for preparation and presentation time measured in terms of credit hours. For the first time a program is presented, CET hours will be received for actual preparation time, up to two times the class hours. For example, if a course is rated as eight CET hours, the instructor should receive up to 24 hours of CET credit (16 hours for preparation and eight hours for class time). For repeated presentations, the instructor should receive no credit unless the subject matter has changed sufficiently to require additional study or research. In addition, the maximum credit for preparation should not exceed 50 percent of the total CET credit an instructor or discussion leader accumulates in a two-year CET reporting period. • Individual Study Programs – Individual study programs that may receive CET credit include correspondence courses and courses given through audiocassettes, tapes, videotapes, and computers. (See the AICPA's standards for more detailed requirements.) F – Staff Qualifications Qualifications for staff members conducting Medicare audits include: • A knowledge of the methods and techniques applicable to Medicare auditing, and the education, skills, and experience to apply such knowledge to the audit being conducted; • A knowledge of the Medicare program; • Skills to communicate clearly and effectively, both orally and in writing; and • Skills appropriate for the audit work being conducted.