decisionhealth Newsletters, Part B News - 2003 Issue 9 (September)
6 tips on how to deal with an audit of your claims
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Article Overview
This article explains what a Medicare claims audit may look like and offers general guidance for practices on how to prepare and respond. It is aimed at providers, office managers, coders, and compliance staff who want to understand the audit process, common documentation issues, and the broad types of information that may be helpful in an audit response.
Why This Topic Matters
Claims audits can affect reimbursement, administrative workload, and compliance risk. Understanding the general audit process and the kinds of documentation reviewers may request can help a practice respond more efficiently and organize its records and supporting materials.
Article Sections
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What to expect
Describes the general Medicare audit process, including how audits are initiated and what reviewers may request from a practice. It also outlines the typical sequence after records are submitted.
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What to do
Provides broad guidance for preparing a response to an audit, including record handling, organization, timing, and the overall structure of supporting materials. It also discusses the role of documentation and practice-level context in the response.
What You Will Learn
- How a Medicare audit is typically initiated and reviewed
- What kinds of records and supporting materials may be requested
- General considerations for organizing and submitting documentation
- How practices can prepare broad supporting information for an audit response
- Common audit-response concerns related to record handling and documentation quality
Who Should Read This
- Physician practices
- Medical office managers
- Medical coders
- Compliance staff
- Billing staff
- Health care administrators
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