How to Respond to a Medicare Audit

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

 "This is a good checklist with suggestions that are generally applicable to responding to record requests, whether they be related to 'audits' or investigations," notes TMA Assistant General Counsel Michael Smith. Here are the high points. Read the full post on KevinMD

  1. Take all correspondence from Medicare, or the Medicare contractor, seriously.
  2. Read the audit letter carefully and provide all the information requested in the letter.
  3. Include a copy of the complete record and not just those from the dates of service requested in the audit letter.
  4. Make sure all the medical records are legible and legibly copied.
  5. If your practice involves taking or interpreting x-rays or other diagnostic studies, include these studies.
  6. Never alter the medical records after a notice of an audit.
  7. Make sure each page of the record is copied correctly and completely.
  8. Make color copies of medical records when the original record includes different colored ink of significance.
  9. Include a brief summary of the care provided to the patient with each record.
  10. Include an explanatory note and any supporting documents.
  11. When receiving a notice of a Medicare audit, remember time is of the essence.
  12. Follow up any telephone communication with the auditor with a letter confirming the telephone conference.
  13. Send all communications to the auditor by certified mail (or express mail), return receipt requested so you have proof of delivery.
  14. Properly label each copy of each medical record you provide and page number everything you provide the auditors, by hand, if necessary.
  15. Keep complete, legible copies of all correspondence and every document you provide.
  16. Consult an experienced health law attorney early in the audit process to assist in preparing the response.
  17. The above checklist is by no means comprehensive. Nor do we mean to suggest that you should respond on your own.  


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Last Updated On

August 27, 2021

Originally Published On

December 19, 2013

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Audits | Medicare | RAC