Medicare Compliance & Reimbursement - 2019 Issue 4
Clip & Save: Review 5 Provider-Audit Hot Spots
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Article Overview
This piece discusses five broad audit hot spots that Medicare Part B coders and compliance teams should understand, including evaluation and management coding, claim frequency, RVU-based utilization, modifier use, and time-related scrutiny. It is aimed at readers involved in audit risk assessment and payment integrity monitoring, and it highlights the kinds of oversight trends and review themes that can affect provider claims analysis.
Why This Topic Matters
Understanding common audit focus areas helps practices and coding professionals prioritize internal monitoring, reduce compliance risk, and recognize the types of claim patterns that attract payer and government review.
What You Will Learn
- The major claim and coding areas that commonly attract audit attention
- How audit focus can vary by utilization patterns, payment magnitude, modifiers, and reported time
- Why these subjects are relevant to Medicare Part B compliance review
- How broad audit risk themes can accumulate across multiple claim characteristics
Who Should Read This
- Medicare Part B coders
- Medical coders
- Compliance officers
- Revenue cycle staff
- Audit and billing professionals
Modifiers Discussed
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