Audits and Records: Are You Among the Providers Who Can't Produce Documentation?

Why This Topic Matters

Missing or incomplete documentation can lead to claim denials, repayment demands, and avoidable audit complications. Understanding the general audit process and record-preparation concerns can help practices respond more effectively to Medicare reviews.

Article Sections

1. Find What the Auditor Is Missing

   This section discusses CERT reviewers’ efforts to obtain supporting records and the challenges that arise when documentation cannot be located or is incomplete. It also references a CMS compliance newsletter and the broader issue of records that do not support billed services.

2. Auditor on the Way? Do This

   This section covers general steps for organizing encounter files and accompanying documentation when an audit is expected. It also warns against altering records and suggests seeking appropriate legal or compliance guidance if problems are discovered.