Nine tips for surviving Medicare audits

Why This Topic Matters

Medicare audits can disrupt operations and create financial risk, so practices benefit from knowing the broad categories of review, the documentation issues that often come up, and the kinds of internal and external help that can improve readiness.

Article Sections

1. Audit preparation tips

   Practical guidance on organizing the response to a Medicare audit and preparing office documentation and support resources. The section focuses on general readiness steps for practices.

2. Official resource

   A brief reference to an external CMS resource related to Medicare audit activity. It points readers toward official program information.

3. Know the types of Medicare audits

   An overview of the major Medicare review and audit programs discussed in the article. The section explains the broader purpose and context of these programs and how they fit into Medicare oversight.

4. Recovery Audit Contractors (RACs)

   Background on one Medicare audit program and its role in identifying payment issues. The section places the program in the larger audit environment.

5. The Medicare Medical Review Program

   Discussion of a Medicare review process focused on evaluating claims and medical records. The section covers the kinds of concerns that can prompt review and the general consequences of findings.

6. Comprehensive Error-Rate Testing (CERT)

   An overview of a Medicare payment accuracy program that reviews claims and documentation. The section describes its general function within Medicare oversight.