Audits

Be On the Lookout for MIPS Audit Request - 06/25/2019

The Centers for Medicare & Medicaid Services has contracted with Guidehouse, a nationwide consulting firm, to audit physicians who participate in the Merit-Based Incentive Program, which is under the Quality Payment Program. If you submitted MIPS data for 2017 and/or 2018, you could receive a request for information via email or certified letter from Guidehouse.


HIPAA Privacy and Security Audits Coming Soon - 05/30/2019

A whole new round of audits — for compliance with HIPAA privacy requirements — are set to begin in early 2013.


Another Possible Audit, This Time for MIPS - 04/19/2018

You could receive a request in the future from the Centers for Medicare & Medicaid Services for an audit of your Merit-Based Incentive Payment System submissions.


Can’t Say It Enough: Document, Document, Document - 12/19/2017

When Medicare delves into claims errors, one stands out: insufficient documentation.


CMS to Expand Audits, Education Targeted to Outliers - 09/13/2017

A new type of audit may be coming your way, as the Centers for Medicare & Medicaid Services puts a pilot claims review program into practice nationwide.


Why, What, and Who Keys to Recoupment-Proof Documentation - 02/08/2017

The lack of a signature on specific portions of an otherwise complete documentation is enough to warrant a Medicare payment recoupment. Here’s what the Centers for Medicare & Medicaid Services found in three Comprehensive Error Rate Testing reviews.


HIPAA Audit, Phase 2: Are You in Compliance? - 02/02/2017

The federal government has begun its Phase 2 HIPAA Audit Program. The program aims to assess compliance with a wide array of HIPAA Privacy, Security, and breach notification rules.


Your Options Following a Recovery Audit Overpayment Determination - 06/03/2016

The Medicare Recovery Audit Contractor (RAC) program is designed to ferret out incorrect payments to physicians, hospitals, and other health care professionals. An appeal to a RAC determination of overpayment is essentially the same as any other Medicare appeal. However, a RAC initial determination is not appealed to the RAC - rather it is appealed to the Medicare carrier, i.e., to TrailBlazer for Texas physicians.


Stay Clear of Medicare Fraud Charges - 06/03/2016

Cracking down on fraud, waste, and abuse in government health care programs has taken a front seat in the U.S. government's drive to control health care costs.


Received a RAC Records Request or Repayment Letter? - 06/03/2016

Texas practices are hearing from Connolly, Inc., the Medicare Recovery Audit Contractor (RAC) for Texas. Be sure to check the validity of any records requests you receive, and weigh your options when responding to a repayment letter.


RAC Auditors Empowered to Perform Complex Reviews - 06/03/2016

Medicare Recovery Audit Contractors now can do complex reviews because limits are set on the number of records they can request (April 2011).


New Toolkit Helps Doctors Navigate Medical Audits - 06/03/2016

The Physicians Advocacy Institute and the American College of Emergency Physicians collaborated to develop the Toolkit for Physicians Facing Medical Audits, which provides practical information and tips to help physicians anticipate medical audits, respond to auditors’ requests for medical records, and appeal erroneous audit findings.


Be Proactive in Preparing for Audits - 06/03/2016

All practices that submit claims to government programs are likely at some point to experience a Medicare Recovery Audit Contractor audit.  If you have not yet prepared for a possible audit, now is the time to get ready and have a plan in place.


Avoid These Six Practices to Stay Clear Medicare Fraud Charges - 06/03/2016

Cracking down on fraud, waste, and abuse in government health care programs has taken a front seat in the U.S. government’s drive to control health care costs. Here are the six top things it is looking for as indications of possible fraud.


New Patient Visit: Three Years Is a Key - 06/03/2016

Centers for Medicare & Medicaid Services auditors have identified claims coded for “new patient” evaluation and management services that don’t fit the definition for new patient services. Be sure to avoid this coding error.


Coding Myths May Place Physicians at Risk - 06/02/2016

Common coding myths may be a contributing factor to revenue loss and risk of a formal audit in your practice. Here are four common myths.


Back to Basics — Documentation 101 and Self-Auditing - 06/01/2016

Who, what (and how many), where, when, and why: These six items comprise a large part of the information Medicare requires to deem a service correct and payable. Documenting them thoughtfully is easy. And double-checking records against claims (and vice versa) is well worth the effort.


CMS Limits Scope of Review on Some Claims - 05/17/2016

The Centers for Medicare & Medicaid Services has narrowed the scope of review for redeterminations and reconsiderations of certain claims denied following a review by a contractor.


Payback Possible - 05/13/2016

Physicians are being chosen by the Centers for Medicare & Medicaid Services (CMS) for electronic health record (EHR) meaningful use audits. Any physician who has received a meaningful use incentive payment is fair game for an audit. CMS expects to audit about 5 percent of participants in the Medicare and Medicaid EHR incentive payment programs. Physicians who have attested to meaningful use or who plan to attest are urged to document the process carefully. They should maintain, for at least six years, documentation supporting the meaningful use measures, calculations, and data submitted during attestation.


Use Correct Surgery Modifiers in Medicare Claims - 05/13/2016

Medicare auditors working under the Recovery Audit program have identified significant payment errors related to surgery. Be sure to bill correctly using these modifiers.


Medicare Will Be Looking for These Documentation Deficiencies - 05/13/2016

Paying attention to CERT audit findings is one way to avoid denied Medicare claims down the road. Here are some documentation elements that warrant your attention.


Medicare Audits Reveal Areas of Under- and Overpayment - 05/13/2016

Medicare RAC auditors have identified an area where physicians tend to be underpaid: multiple surgeries. In other areas, Medicare has overpaid. Here are some billing errors to avoid.


How to Respond to a Medicare Audit - 05/13/2016

TMA Practice E-Tips editors ran across this excellent checklist of “17 tips from a lawyer” on how to respond to a Medicare audit.


If Your Practice Is Selected for a CERT Review - 05/13/2016

Respond promptly to a CERT request for information by submitting the requested supporting documentation within the time frame outlined in the request.