Do We Need a Healthcare Attorney in the Event of a Medicare Audit?

If your healthcare organization is facing an audit from Medicare, there are several steps you can take to manage this audit effectively and to minimize any penalties for your organization.  It’s important that you take all Medicare audits seriously, because each separate audit has the potential to result in additional payments on behalf of your practice.

There are multiple types of Medicare audits but they all fall into two general categories – prepayment audits and post-payment audits.  Many prepayment audits occur as a matter of course involves the review of claims before Medicare actually pays a physician, hospital, or other healthcare provider.  Post-payment audits involve analyzing claims after payment has already been made – some of which are conducted automatically and some that are more complex and require submission of medical documentation.   There are different types of Medicare contractors who perform audits depending on the type of audit at issue.  These include the Medicare Administrative Contractors (MAC), Recovery Audit Contractors (RACs), Comprehensive Error Rate Testing contractors (CERT), and Zone Program Integrity Contractors (ZPICs).  Regardless of the type of audit, it can be very beneficial to have a Bossier City healthcare attorney guide you through the process.  It’s important you understand compliance issues and proper filing with Medicare in order to prepare for both kinds of audits.

If an audit results in a finding of overpayment to the physician, hospital, or other healthcare provider, it must be determined whether to appeal the determination.  There are many cases in which the audit findings are incorrect could be wrong.  Having a Bossier City healthcare attorney advising you about the best option to take in your case can make a difference in the ultimate outcome.   Do not assume that any of the Medicare contractors or even CMS has your best interests in mind during an audit.  Instead, you should hire legal representation who will look after your interests in the event of an audit.

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