Preparing for a Medicare Audit

ABSTRACT

Anyone who is a Medicare participating provider can be audited at any time by Medicare. One can be prepared by developing and following a practice compliance program. There are steps you can take to prepare for a Medicare audit. Prepayment and postpayment audits will be discussed as well as appealing your carrier's overpayment claim. It is important to understand what Medicare considers fraud and recognize reasons why Medicare claims are rejected. There is no need to panic if you receive a letter from your Medicare carrier requesting review of specific patient charts or a letter requesting a refund due to overpayment. A Medicare audit should be taken seriously. With good record keeping and adhering to Medicare guidelines, going through a Medicare audit will have minimal impact on your practice. Your practice will survive a Medicare audit.

KEYWORDS

Diagnostic audiologic testing - practice compliance program - prepayment audits - postpayment audits - Medicare fraud

REFERENCES

• 1 U.S. Federal Government .Federal Bureau of Investigation homepage. Available at: http://www.fbi.gov/hq/cid/fc/video_tex/hcf_txt.htm Accessed April 4, 2007
• 2 False Claims Resource Center homepage .Available at: http://www.falseclaimsact.com/description.html Accessed April 4, 2007
• 3 Roediger J D. Who's Afraid of a Medicare Audit? Practical Advice for Getting Through It (Physician Practice Publication). Gainesville, FL; Shands Health Care 2002
• 4 Glaser D. Understanding and surviving Medicare audits.  Minnesota Medical Association. 2000;  83
• 5 Harrington S. When Medicare says, “Let's see your records”.  Medical Economics. 1999;  76 142