By: Wendy Miller, BOCO, CDME
No one likes to be audited. In fact, the word "audit" has become synonymous with pain, frustration, and loss of productivity and revenue. I want to encourage you to take a deep breath, try to remember the intention behind audits (to limit fraud, waste, and abuse), and follow these tips:
1. Educate and train your staff on Medicare and the audit process. If your staff understands Medicare standards and requirements, they'll know what documentation to keep and for how long.2. Create an audit team. Everyone on your staff should have a general idea of what CMS does and how it operates, but choose 3-5 individuals to receive additional training in Medicare and billing, and to attend industry events. This team should be made up of good communicators who are detail oriented and problem solvers. Place someone on the team who has been through an audit before.3. Keep all CMS files for at least five years. While CMS typically reviews claims from the past three years, retaining them for five years adds peace of mind for you and your team.4. Conduct an internal "practice audit" annually. This is a great exercise for your audit team. Review randomly selected Medicare claims for the past five years and see if you notice billing and coding errors. If you find any, develop and execute a plan to correct similar errors.5. Review BOC's Accreditation Standards Guide. This document, which encompasses CMS Quality and Supplier Standards, is an easy-to-use document that helps to explain what is required for your facility to be in compliance with CMS. Pay special attention to the section on Performance Management, as it provides specific tips on tracking, billing, and coding errors.