tci Medicare Compliance & Reimbursement - 2019 Issue 3
Put These 5 Focus Areas On Your Audit Radar
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Article Overview
This piece discusses five broad areas that Medicare claims auditors and related reviewers may examine when evaluating provider billing patterns. It is aimed at coders, compliance staff, and billing professionals who want to understand the general audit landscape and the kinds of utilization and documentation topics that can draw attention. The article focuses on audit risk areas, reviewer priorities, and the types of coding and reporting patterns that may be monitored.
Why This Topic Matters
Understanding common audit focus areas can help billing and compliance teams recognize where claims patterns may attract review and where internal monitoring may be useful.
What You Will Learn
- The main categories of billing activity that can draw Medicare audit attention
- How auditors may look at utilization, frequency, and time-related reporting patterns
- Why modifier usage and service-level patterns are common review topics
- How audit risk can increase when multiple billing patterns appear together
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Practice managers
- Revenue cycle teams
Modifiers Discussed
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