Audit Preparedness: Prep For These Common Audits Your Practice Could Soon Face

Why This Topic Matters

Audit activity can affect payment, documentation burden, privacy and security compliance, and operational risk. Understanding the different review programs helps practices organize records, policies, and internal processes before an audit request arrives.

Article Sections

1. Watch for ADS Letter From Your MAC

   Introduces Medicare Administrative Contractor review activity and the initial audit notice process. Discusses the general importance of responding to documentation requests carefully.

2. Focus on Post-Payment for CERT Audits

   Summarizes the CERT audit program and its post-payment review role. Notes how review findings can affect later contractor activity and broader compliance focus.

3. Distinguish Automated and Complex With Recovery Auditors

   Describes the two general review formats used by recovery auditors and the types of materials they may examine. Also introduces audit focus areas related to claim submission details and payment issues.

4. Raise a Red Flag If ZPICs Come Knocking

   Covers Zone Program Integrity Contractor activity and its fraud-and-abuse orientation. Explains the broader investigative nature of this review process.

5. Form a Team to Prep for HIPAA Audits

   Outlines general preparation steps for HIPAA privacy and security audits. Emphasizes policies, procedures, risk analysis, and documentation practices.