AUDITING 202: Stave Off Allegations That You've Wronged Medicare: Use This 3-Pronged Approach to Self-Audits

Why This Topic Matters

Self-auditing can help organizations detect billing problems earlier, strengthen compliance processes, and better prepare for government scrutiny or whistleblower concerns. The article is relevant to providers seeking to manage audit risk and understand broad response options when internal reviews uncover potential errors.

Article Sections

1. Prepayment reviews and internal claim controls

   This section discusses prospective audit approaches and how organizations can use internal review processes to monitor claims before submission. It also touches on broader operational compliance practices in provider settings.

2. Routine retrospective audits

   This section covers the general advantages and risks of looking back at previously submitted claims. It also discusses when organizations may choose to review past billing activity based on internal concerns or external exposure risk.

3. What to do if improper billing is uncovered

   This section addresses broad response considerations after an internal review identifies potential billing problems. It discusses how the scope and pattern of issues can affect next steps and why legal and compliance review may be involved.