Preparing for Audits: It’s Not a Question of ‘If’ but ‘When’

ATLANTA — In case you have been spared so far and haven’t
noticed, Medicare claims audits conducted by multiple government
contractors are spreading throughout the country. The effect has
been devastating, particularly for those providers who, in some
audits, are placed on 100 percent prepayment review (meaning that
all of their claims must be reviewed before they are paid). In that
case, Medicare cash flow dries up for as long as 90 days — or
much longer.

The following two Q&A interviews with health care attorney
Jeff Baird of Amarillo, Texas-based Brown & Fortunato and
consultant Wayne van Halem of The van Halem Group, Atlanta, address
both the whys and hows of audits.

We begin with Baird, who focuses on prepayment reviews, while
van Halem concentrates on the issue of documentation. According to
both of these experts, getting prepared — and staying
prepared — is a provider’s best defense.

Baird reminds that a special Audit
Task Force formed by the American Association for Homecare is
gathering information to present to CMS and legislators on Capitol
Hill about the situation. “The goal of the task force is to
persuade (or cause) CMS to back off the draconian ways that it is
conducting prepayment reviews and post-payment audits,” he
explains. “Until this happens, however, suppliers must figure out
how to prepare for and survive prepayment reviews.”

As van Halem notes, “It’s not a question of ‘if’ you are going
to be audited, it’s a question of ‘when.’”

To share examples of crippling audits or
contradictory policies across audit types, fill out the form on the
AAHomecare
website (click “Medicare Audit Survey” under “What’s New”) and
get it in by Sept. 24.