How to survive the dreaded Medicare audit

Why This Topic Matters

Medicare audits can be time-consuming and costly, so advance preparation can help practices respond more efficiently and present supporting documentation in an organized way. The article matters to anyone responsible for compliance, billing, coding, or legal response planning.

Article Sections

1. Preparing for a Medicare audit

   Introduces the audit context for physician practices and emphasizes proactive readiness. Discusses broad strategies for reducing disruption and responding in an organized way.

2. Review the audit request

   Explains how to assess what the auditor is requesting and what the request may be targeting at a general level. Focuses on understanding the scope of the records involved.

3. Understand the deadlines

   Covers timing considerations for audit response, including the need to confirm delivery requirements and manage turnaround time. Also addresses record tracking and extensions in general terms.

4. Retain qualified legal counsel

   Discusses involving legal counsel with audit experience in the relevant specialty. Covers sharing the audit letter and requested materials and coordinating the response process.

5. Research Medicare policies

   Highlights the importance of reviewing Medicare policy sources before responding to an audit. Mentions CMS manuals, transmittals, and local coverage determinations as relevant references.

6. Compile legible documentation

   Addresses record readability and organization as part of the audit response. Includes general documentation cleanup and abbreviation support.

7. Retain a qualified auditor

   Describes the role of an outside documentation and billing auditor in preparing for payer review. Emphasizes specialty familiarity and record compilation support.

8. Retain medical experts

   Covers the value of clinical and coding experts in supporting a practice’s audit response. Notes their potential importance in both administrative review and litigation settings.