Preparing for the Medicare Annual Election Period
How to Prepare for Your Next Medicare Audit
No one likes to be audited, especially by the federal government. However, the increase in Medicare abuse has caused the Centers for Medicare and Medicaid Services (CMS) to consistently audit the healthcare providers, hospitals and nursing homes that receive federal Medicare dollars. Audits are meant to recover any inaccurate or improper payments that were made via Medicare claims. Prepare for your next Medicare audit by educating your staff, keeping your files detailed and updated and conducting regular internal audits to ensure your Medicare claims are legal and correct.
Meet the deadline.When you receive a letter notifying you of a Medicare audit, you will have 45 days to respond and schedule the audit dates.
- Respond to the letter immediately. Schedule the audit and make sure the date sticks. Many auditors travel, and canceling and rescheduling is inconvenient and not a good way to gain favor with your auditor.
- Avoid missing the deadline or trying to delay the audit. This will only cause problems for you and raise suspicion with the Recovery Audit Contractor (RAC) who conducts the audit.
Educate your staff.Everyone in your practice, hospital or healthcare facility should understand the importance of the Medicare audit.
- Run a training or a seminar on Medicare and the purpose of the audit. Not only will this keep your staff informed, having such a training on the books will demonstrate to CMS and your RAC the seriousness with which you take the matter.
- Encourage extra professionalism on the days of the audit. Remind employees not to discuss patients or cases in public areas.
Create an audit team.Having a dedicated group of employees trained and prepared to respond to an audit will keep the process streamlined and efficient.
- Invite your smartest employees and best communicators to be on the audit team. It would also help to have someone on the team who has been through an audit before.
- Task the team with keeping management updated and informed as they prepare files for the audit.
Gather information.The CMS provides quarterly provider updates which your audit team should collect and review.
Review past audits.If previous Medicare audits have revealed improper payments or coding mistakes, make sure steps were taken to rectify those problems.
Pull Medicare files from up to 4 years ago.Medicare is permitted to look at Medicare claims as old as 4 years.
Conduct an internal audit.
- Determine whether any mistakes were made in Medicare payments in the last 4 years so you will be prepared for any issues that the auditor uncovers. Having a plan in place to correct those mistakes will save you a step after the audit.
Use all available technology.
- Use programs that are specifically designed for Medicare audits. You can electronically respond to the audit letter and begin to prepare your files.
- Look for a program that works well for your staff. There are web-based portals, software programs and other tools that will allow your audit team to track and respond to internal and external issues.
Decide who will meet with the RAC.This will depend on the size and operation of your facility. Sometimes, the CEO meets with the auditors, and sometimes it is an administrative manager.
- Make sure your facility's representative is polite, professional and flexible. He or she is the person who will have to provide any last minute information or respond to the RAC's (Recovery Audit Contractor) requests while he or she is on site.
- Set aside a conference room or a private workspace for the auditor. Make sure it includes space for a computer and files. While many of your files will be electronic, there might still be some paper files to comb through.
Video: Medicare Open Enrollment 2018 - What to do... What not to do...
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