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Medicare And Medicaid Audits


If your medical practice accepts Medicare and Medicaid, you may be at risk for an audit. As instances of medical fraud have risen, the government has developed 7 different types of audits to prevent overpayments, underpayments, waste and abuse in the healthcare system. Appealing a decision made as the result of an audit can be incredibly costly and complex, so it’s best to make sure your billing, invoicing, and payment systems can stand up to Federal scrutiny.

Some of the most common types of audits include:

  • Medicare and Medicaid RACs, which look for overpayments and underpayments in your billing.
  • Keep in mind that RAC audits can examine your records from the past three years, and that auditors receive compensation based on the amount of discrepancies they find.
  • MICs, which also look for overpayments but focus more on education and fraud reduction.
  • MIC auditors are paid based on how effective their audits prove to be.
  • ZPICs, which seek to identify abuse and fraud.
  • ZPICs are not random audits, but are conducted when a medical practice is suspected of billing fraud.

In order to survive an audit, your practice must develop a comprehensive error-prevention system that includes experienced medical billing specialists, cutting edge software, and clearly established policies for rectifying billing and payment mistakes.

To learn more about practice setup, finance, billing, insurance, coding, outsourcing…everything a health care provider need to succeed, join DoctorsBusinessNetwork.com or visit Doctors Business Channel on YouTube!

Author: DBN

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