How To Prepare For A Medicare Audit

1
How To Prepare For A Medicare Audit
2
How To Prepare For A Medicare Audit

• Hospital administrators, physicians, and members
  of every healthcare office billing department
  know that if their practice or hospital provides
  services to Medicare patients, they must be
  prepared to potentially receive a request for an
  audit. The Centers for Medicare and Medicaid
  Services (CMS) is responsible for devising the
  audit strategy and enforcing it on a year-to-year
  basis. Medicare audit process may seem
  overwhelming, but becoming familiar with the
  process will allow your organization to be
  prepared if an audit does occur. CMS also
  provides documents online to help you further
  understand the process in more detail. To help
  prepare you to deal with this likely occurrence,
  we shared guidance for compliant documentation
  and timely response to auditors. When you are
  prepared for Medicare audit, it can ease the
  audit discomfort and enable you to focus on
  caring for patients.
• Responding to an Audit Request
• Once you have gathered all the paperwork needed
  to support your claim, make two sets of copies of
  everything you are sending. Keep one set for
  yourself, so you know exactly what each packet
  contained. Follow these guidelines for assembling
  and submitting your responses
• Include a cover letter explaining that you are
  replying to their request. Include in the cover
  letter the telephone number auditors should use
  to contact you or your representative if any
  questions arise.
• Next include a copy of the ADR as the first sheet
  in each packet.

3
How To Prepare For A Medicare Audit

• Write an individual summary of each record,
  detailing the medical issues addressed in your
  documents include the patients name, date of
  birth, HIC number, medical condition,
  prescribers names, etc., and discuss what will
  be found in the enclosed documents.
• If anything in the ADR is not included, mention
  that in the written summary. For example, if
  physician documentation doesnt arrive in a
  timely manner, note that physician documentation
  is lacking but will be forwarded when it becomes
  available.
• Assemble the documents in the order listed on the
  ADR, and put each file in the same order.
• Pack into an appropriate box with a list of all
  records contained in each box.
• Keep copies of everything sent.
• Send via any method of return receipt to ensure
  delivery at least one day before your deadline.
• Prepare for a Medicare Audit
• Most CMS notifications arrive by mail, so make
  sure your front office knows what to do with
  these letters when theyre received. CMS only
  allows a window of 45 days to respond, so time is
  of the essence and unpaid claims may be the
  result of missing the deadline.
• A Medicare audit is not something to take lightly
  and everyone in your staff must understand how
  important it is to comply accordingly.
• CMS will notify about the submissions under
  review and supporting documents are needed.
  Select team members to run point on this to
  streamline communication within the office and
  with the Medicare contractor.

4
How To Prepare For A Medicare Audit

• If youve been audited by CMS previously, review
  those audits. Make sure your staff took the
  proper steps to rectify the problems that
  triggered the previous audits. Medicare can look
  at claims as old as four years, so review as many
  claims as possible and look for mistakes. If you
  have a plan in place to correct the mistakes you
  discovered, it will save time during the audit.
• When gathering the necessary documentation for
  audit resolution, ensure complete prescriber
  medical records. Organizing and storing complete
  documentation can be time consuming but
  essential.
• Its always advisable to complete documentation
  at the time of service than try to piece the
  puzzle together at the time of an audit, which
  could potentially occur years after the claim has
  been paid. Medical records must specify each
  patients diagnosis and detail the medical
  necessity for the equipment.
• Your point person is critical in the auditing
  process, he or she must be knowledgeable and
  well-informed on Medicare billing practices and
  your own internal billing systems.
• A Medicare audit is not something that should be
  taken lightly, but it can be prepared for ahead
  of time by instituting best practices. By knowing
  what errors are most common, you and your staff
  can determine which areas you are already
  proficient in and which areas may need
  improvement. When it comes to a Medicare audit,
  being prepared and ahead of the curve is always
  the best course of action.

5
How To Prepare For A Medicare Audit
Medisys Data Solutions is a leading medical
billing company providing complete assistance in
medical billing and coding. By implementing
processes that follow CMS regulatory guidelines
for Medicare, your healthcare organization can be
confident in your ability to weather an audit. To
know more about our billing and coding services,
contact us at info_at_medisysdata.com/ 302-261-9187.
6
(No Transcript)