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Physicians Practice. Vol. 16 No. 9
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Medicare: When the Auditor Comes Calling

How to best respond to — and prevent — a CMS audit

By Suz Redfearn | June 1, 2006


Let sleeping dogs lie, says Glaser.

“If you don’t hear from them, don’t call and check. No news is good news. Let it sit,” he advises. “Maybe they’ll forget about you — I’ve seen that happen.”

And be patient, he adds. Results from a Medicare audit can take months — even years. Put it out of your mind and remember that jail time for infractions is exceedingly uncommon — usually only seen when out-and-out fraud is apparent, says Glaser.

Yes, a Medicare audit can be a tremendous drag on your resources, time, and emotions — but if you can, focus on the upsides, suggests Wheeler. Surprisingly, she says there is more than one.

“In looking closely at your records during an audit, you may discover areas where you’re not capturing revenue to the greatest extent allowable by revenue rules — or you could find ways to tighten internal control that would help the bottom line,” Wheeler says. “Try and view the audit as an opportunity to shine and let CMS see what you’re doing right.”

Suz Redfearn is a freelance writer and editor with more than 10 years of experience writing about business and healthcare issues. She can be reached via editor@physicianspractice.com.

This article originally appeared in the June 2006 issue of Physicians Practice.

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Receiving notice that you are the subject of a Medicare or Medicaid audit by CMS can be very frightening. Take these steps to ensure your practice is in order:

  • If CMS sends your practice an audit letter requesting copies of records, contact your attorney immediately. He or she will help you determine whether CMS is doing a routine review or a targeted investigation.

  • Before sending the requested records to CMS, it is advisable to have your attorney contact a coding consulting company on your behalf to determine what CMS may be looking for. This makes any mistakes you find legally undiscoverable.

  • Work swiftly to send CMS the records it has requested. Assign the matter to one person in your office who can handle it efficiently and responsibly.

  • To avoid an audit in the first place, adhere to a strict, ongoing compliance plan that includes internal audits twice a year as well as frequent staff training.







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