Medical Practice Management
Mar 06

Are you ready for a CMS audit??

Seems the Medicare carriers are starting to conduct chart review audits around the country. The following are excerpts from recent listserv posts:

“Recently we have seen more requests for Medicare Records and in the just recent past these have revolved around IP consults.  I am wondering if this is specific to our state, (or perhaps our practice) or a nationwide phenomenon.  These are pre-payment and my second question is do any of you have any idea how long it takes once the records are sent before CMS reviews and pays the claim?  I am watching these claims, but wondered what the experience of the group has been?”   

“Our office has recently received requests for documentation on inpatient consultations from CMS (prepayment audits).  Our coder reviewed them again to check on our compliance and we are confident that coding and billing was done correctly.   We have not received a response back on those reviews (nor payment) yet, but are anxious to see what the outcome is”

The point to be made here is simple – can your medical record documentation withstand a Medicare audit or any related audit by a third party payer? From a compliance and education standpoint, I always recommend that physician practice get annually an independent review of medical record documentation. I want to stress the word INDEPENDENT………….a good compliance program doesn’t try to 100% “police” itself internally.

About Reed Tinsley, CPA

As a top advisor to physicians, I help increase practice profits by delivering hands-on, expert medical accounting/tax support, practice counsel, and revenue-building strategies. Read more →