How to survive a Medicare audit

Why This Topic Matters

Medicare audits can disrupt practice operations and create financial exposure, so understanding the process and the categories of audit activity helps practices respond more effectively and plan ahead.

Article Sections

1. Preparing for an audit

   General steps practices can take when an audit is initiated, including process management, records review, documentation handling, deadlines, counsel, and external support resources.

2. Know the types of Medicare audits

   An overview of common Medicare audit program categories and the broader reasons claims or records may be selected for review.

3. Recovery Audit Contractors (RACs)

   Background on one of the Medicare audit program types discussed in the article and its role in identifying payment issues.

4. The Medicare Medical Review Program

   A description of another Medicare review program and the general factors that can lead to claim examination.

5. Comprehensive Error-Rate Testing (CERT)

   An overview of the CERT program and its purpose in evaluating the accuracy of fee-for-service claims.