Know the types of Medicare audits

Why This Topic Matters

Understanding Medicare audit types helps practices recognize what may prompt scrutiny, prepare documentation, and reduce avoidable billing and compliance issues.

Article Sections

1. Recovery Audit Contractors (RACs)

   Discusses one Medicare audit program and its role in reviewing paid claims, including the broader purpose of contractor-based recovery efforts and how the program fits into Medicare oversight.

2. The Medicare Medical Review Program

   Covers another Medicare review process focused on claim review, medical necessity, and related billing, documentation, and coding concerns. The section also notes possible follow-up actions when issues are identified.

3. Comprehensive Error-Rate Testing (CERT)

   Describes the Medicare payment accuracy review program that uses claim selection and record review to assess compliance with coverage, documentation, coding, and billing requirements.