How to Respond to a Medicare Audit

Make copies of records and correspondences during the audit for it to go smoothly.

If you aren't thinking about the aftermath of Medicare audits until they become a possibility, you may have already set yourself up for failure to prevail. Before an audit happens, you should know how to react and have sufficient processes in place for responding in a timely manner. It's preemptive measures such as peer review and a focus on compliance that will give physicians a winning start.

When working with an auditor, make sure you provide all the information requested—including complete and accurate records. Assuming that this has been done, it's important to verify the auditor's findings. The Physicians Advocacy Institute and American College of Emergency Physicians place this on the list of the top ten things physicians should do when negotiating impending audits.

According to the list, when an overpayment is based on extrapolation, you should always double-check the auditors extrapolation methodology. It's possible an auditor could make an error and you have the right to request a full claims review if necessary.

In an instance where a physician does disagree with the audit findings, it's important to understand the appeals process, which can help to refute erroneous findings. Don't wait until the demand letter arrives. Know what you need to do, now, in order to win or prevail when faced with a Medicare audit.

One final piece of advice is to focus on documentation during each step of the audit process. Keeping track of communications with the auditor, even if it's by phone, will provide solid records for use in any potential future judgment.

Even with all of these precautions, mistakes do happen. Risk is an unavoidable part of doing business. By partnering with a consultant who is experienced in regulatory and compliance laws, your organization will be equipped to take corrective action that will improve your risk management capabilities for the future.

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