How To Prepare For A Medicare Billing Audit


How To Prepare For A Medicare Billing Audit


A doctor’s main concern is for his or her patients. Making sure that every person under their care has reliable, high-quality services to help them address or prevent illness is their top priority. Most doctors don’t spend a lot of time thinking about what happens after they leave the examination room, let alone when a claim for payment leaves their office on its way to the insurance company.

As an experienced criminal justice attorney in Newark, Robert J. DeGroot knows that what happens during the billing process can have a big impact on the future of any medical practice. Mistakes, omissions, and in some cases, intentional falsification of insurance claims to Medicaid or Medicare can trigger an audit and site visit from the Centers for Medicare and Medicaid Services (CMS).

A Few Things to Keep in Mind

In some cases, you’ll have less than 24 hours notice that this investigation is going to occur. The important thing is not to panic; call a criminal justice attorney in Newark right away. Then, use this list of tips to make sure you’re ready when the Medicare administrative contractor or zone program integrity contractor (ZPIC) arrives.

1. Double Check The Address

If for some reason the government doesn’t have the accurate address of your practice it could cause bigger problems. Contact PECOS and/or the National Plan and Provider Enumeration System online to change it immediately. Then, contact the auditors themselves and make them aware of the discrepancy.

2. Contact Your Attorney

It’s essential that you have legal representation during the audit. This is your right and can protect you from an unfair investigation. Make sure your attorney is experienced in medical billing audits.

3. Make Sure Your Office Is Organized And Clean

First impressions are everything, and you don’t want to welcome an auditor into a chaotic office situation. Call a housekeeping service if necessary to make sure that things are clean, organized, and inviting.

4. Create A Space For The Audit To Take Place

It’s essential that the auditors have ample space in which to complete their investigation, preferably out of sight of your patients and employees. Set aside a conference room and make sure there’s a table and chairs available for interviews.

5. Instruct Your Staff About What’s Happening

If you don’t tell your staffers what’s going on, they’ll speculate the worst. Gather them together, calmly explain the audit in broad terms, and instruct them to comply and always tell the truth. Having your attorney present during this meeting can also be beneficial, in case he or she has special instructions for your staff members.

6. Make Lots of Copies

It’s generally advisable to make two copies of every document requested by the auditors. One is provided to them and one should be provided to your legal counselor. This ensures that everyone is aware of what information has been obtained by the other parties, so that a defense can be formulated from the very beginning of the process if necessary.

Put Your Trust in an Experienced New Jersey Criminal Lawyer

At the Law Offices of Robert J. DeGroot, we know how stressful it can be to face an audit. Contact us for the guidance that only an experienced criminal justice attorney in Newark can provide.

With over four decades of experience in the industry, Robert DeGroot can help. No matter what you’re facing, our team of legal experts is here to provide you with all of the information you need to make sure that you’re headed in the right direction. As you are probably well aware, there are a number of moving parts to consider during this process but we’ll be here to make sure that everything is in order. Reach out to our team today to get the help you need.