How Should I Navigate a Medicare, Medicaid Billing Audit?

You must be made well aware that it is not necessarily a routine procedure to be subject to a Medicare or Medicaid billing audit. Rather, you are being posed with this because this government organization has reason to be suspicious of you. Overall, if things do not go well, this audit can disrupt your medical practice, impose hefty reimbursement amounts, and have you facing many more types of serious consequences. So it is best that in the coming days, weeks, and months, you carry yourself appropriately. With that being said, please read on to discover how to navigate the complexities of a Medicare or Medicaid billing audit and how one of the seasoned HMO/Medicare/Medicaid audit protection lawyers at Walker Medical Law can help you stay out of any potential trouble.

Why did I receive a Medicare or Medicaid billing audit notice?

Medicare and Medicaid use extensive data analytics to identify billing patterns that fall outside normal ranges. So, one of these government organizations will be able to easily identify when your medical practice bills more frequently, when your bills entail more high-value codes, and when you use more unusual modifiers than the standard averages amongst similar providers. Ultimately, their analytics system will flag these activities for review and trigger an audit notice.

But also, these organizations take complaints from patients, staff, and other medical providers very seriously. These anonymous or identifiable complaints may allege that your medical practice bills too much for provided services, coerces patients to undergo and pay for unnecessary services, or poorly documents the types of services provided to patients. Even if these complaints are only supplemented with meager evidence or leads, Medicare or Medicaid may do their due diligence in running an audit against you.

How should I proceed immediately after receiving an audit notice?

When you initially receive an audit notice from Medicare or Medicaid, you must not panic and remain focused. That is, you must carefully read the notice and note the important deadlines for submitting documents and responding to other requests. From here, you must make efforts to gather this requested documentation and anything else you may deem relevant to your defense, such as patient charts, doctors’ notes, appointment logs, billing ledgers, coding sheets, internal correspondence, etc.

If you have billing teams and office managers on staff, you should calmly inform them of this upcoming audit procedure and the possibility of them being interviewed. They may even assist you in collecting the evidence you need, but at the same time, you should discourage any informal talk about what is happening, especially with those outside of these departments. Lastly, before you come face-to-face with auditors, you should retain legal representation for you and your supporting staff.

If this is what you are currently up against, do not try to put up a fight without the legal assistance of one of the competent HMO/Medicare/Medicaid audit protection lawyers from Walker Medical Law. We urge you to retain our services as soon as possible.