How to survive the dreaded Medicare audit

Why This Topic Matters

Medicare audits can disrupt workflow, require substantial record production, and lead to payment recoupment or further review if documentation does not support the billed services. Understanding the audit process and the major Medicare review programs helps practices organize evidence, reduce avoidable problems, and respond more effectively if selected.

Article Sections

1. Preparing for a Medicare audit

   Overview of practical steps a practice can take when audit activity begins. Covers organization, documentation readiness, deadlines, and the role of support professionals.

2. Official resource

   References a CMS resource for additional information on Recovery Audit Contractors and related program materials.

3. Know the types of Medicare audits

   Introduces the major Medicare audit and review programs discussed in the article and explains that they can arise from different triggers and sources.

4. Recovery Audit Contractors (RACs)

   Describes the RAC program at a high level, including its place in Medicare oversight and its role in identifying payment issues.

5. The Medicare Medical Review Program

   Summarizes a Medicare review process focused on claim review, documentation, and payment accuracy, including common triggers for review.

6. Comprehensive Error-Rate Testing (CERT)

   Provides a general overview of a Medicare payment accuracy program that reviews sampled claims and associated records for compliance with coverage and billing requirements.