Medicare, Medicaid & Payer Audit Requests Payers are auditing claims at an increasing rate. Be prepared! Have a process

Medicare, Medicaid & Payer Audit Requests

Payers are auditing claims at an increasing rate. Be prepared!

Have a process to ensure the packets are reviewed and completed before submission.  Here are a few tips to stay prepared:

• Attach copies when you bill a code
• Monitor the time frame it takes to gather records
• You CAN contact an attorney if a payer rep shows up on-site

Key Items To Consider:

1. Look at the date of service in question and provide everything that applies to that date of service.
2. Chart Note (physician)
3. Test ordered with interpretation or sign-off reviewed (physician/home health/hospice); even if not billed, it may have been used in the coding of the evaluation and management.
4. Labs ordered/billed with interpretation or a sign of review (physician/home health/hospice); even if not billed, it may have been used in the coding of the evaluation and management.
5. Pictures (physician/home health) • Wound care, especially
6. Orders/RX/Standard Written Order—DME/HH/Hospice
7. Any CMN or required forms, Title 19, etc.—DME/Home Health/Hospice
8. Delivery Ticket (DME)
9. Nursing/aid visit evidence (home health/hospice)
10. Medical Records/Sleep Study (DME/sleep lab)
11. Prior Treatments Tried (Grafting, Physician, DME)