Audits: This MAC Shares the Dirt on 4 Common Audit Types

Why This Topic Matters

Understanding which Medicare reviewer is requesting records affects documentation response, audit preparation, and appeal deadlines. The article helps readers distinguish among audit functions and recognize why record completeness and timely follow-up matter.

Article Sections

1. Introduction

   A brief setup describing the variety of Medicare audit requests providers may receive and the source webinar used to explain them.

2. Medicare Administrative Contractor (MAC)

   A general discussion of MAC review activity, including claim review timing and record request notices.

3. Comprehensive Error Rate Testing (CERT)

   An overview of CERT as a post-payment review program and the kinds of documentation issues it addresses.

4. Recovery Auditors

   A summary of recovery auditor review scope, lookback period, and the general difference between automated and complex reviews.

5. Zone Program Integrity Contractor (ZPIC)

   A discussion of ZPIC review functions, including integrity-focused activity and referral pathways.

6. You Can Appeal Audit Decisions

   General information on appeal availability and timing for different Medicare audit processes.