Part B Insider - 2015 Issue 3
Unfavorable Audit? Don't Think Twice About Appealing
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Article Overview
This article explains why medical practices may consider appealing unfavorable Medicare audit findings, with emphasis on RAC activity, extrapolation, statistical sampling, and related CMS appeal considerations. It is aimed at practice leaders, compliance staff, and coding/billing professionals who want a high-level understanding of when audit results may be contested and what general categories of guidance are discussed.
Why This Topic Matters
Audit findings can affect reimbursement, compliance risk, and future review activity. Understanding the general appeal landscape helps practices evaluate whether an unfavorable determination should be contested.
What You Will Learn
- Why unfavorable Medicare audit findings may be appealed
- How extrapolation and statistical sampling factor into audit reviews
- What general sources CMS may use to identify broader payment error concerns
- Which types of appeal-related issues are discussed at a high level
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Practice administrators
- Physician group leadership
Codes Discussed
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