COMPLIANCE: Take Initiative--5 Steps Can Help You Handle Medicare Audits

Why This Topic Matters

Medicare audits can affect claim integrity, compliance workflows, and practice operations, so understanding the general preparation and response themes can help organizations reduce avoidable risk and respond professionally when review occurs.

Article Sections

1. Staying Current With Medicare Requirements

   Introduces the importance of monitoring payer policy changes and maintaining awareness of evolving requirements that can affect claims compliance.

2. Documentation Accuracy and Support

   Focuses on maintaining documentation that supports services reported on claims and on avoiding gaps in the medical record.

3. Understanding the Scope of an Audit

   Addresses asking for the purpose and scope of a review when contacted by an auditor and involving appropriate advisors when needed.

4. Gathering Documentation for Review

   Covers the general need to assemble records for auditor review and to be prepared for requests involving claim support materials.

5. Keeping Records of What Auditors Review

   Discusses maintaining a record of materials examined during the review and organizing follow-up if additional explanation is needed.