What is Medicare Audit: Who Investigates You And What You Are Exposed To

All health services facilities that offer services to beneficiaries of federal programs such as Medicare and Medicaid are exposed to investigations and Medicare audits. Some audits have or may have a purely economic impact, but others may have criminal consequences. Therefore, it is important to know who carries out the investigation / Medicare audit and what the exposure is. This will allow you to take the appropriate measures to manage the process and reduce the risks involved. Are you looking for Medicare audit help? Look for Medicare audit services today! 

Medicare Recovery Audit Contract Program

In January 2010, Centers for Medicare and Medicaid Services (CMS) implemented the Program, known as the Medicare Recovery Audit Contract Program, whose purpose is to audit claims paid for services provided under Parts A and B of the Medicare Program. Which is why it is also known as The Medicare Fee for Service (FFS) Recovery Audit Program. To carry out the necessary audits, CMS hires certain entities (Program Integrity Auditors) that are constituted in its operational arms, and who have the task of ensuring that Medicare pays:

• The correct amount for covered services;
• For correctly coded services;
• For services provided to eligible beneficiaries; and to authorized suppliers.

Audits are governed by the CMS Program Integrity Program Manual (PIM), which is reviewed at least annually. The Integrity Auditors (Program Integrity Auditors), in general terms, are divided into the following four categories:

1. Audit Tracking
2. Audit Processing
3. Desk Audit Review
4. Onsite Field Audit

Are You Concerned About Current Or Future Medicare Audits?

The Recovery Audit Contractor (RAC) Program was authorized by Congress to identify undue payments (overpayments and incomplete payments) from Medicare (state health insurance). The Centers for Medicare and Medicaid Services (CMS) named four permanent Medicare Recovery Audit Contractors (RACs) as part of the nationwide program implementation. These contractors identify Medicare improper payments and receive a conditional fee based on a percentage of improper payments that they identify and collect.

The Permanent RAC Program Allows Claims To Be Audited For The Following Types Of Providers:

for inpatients and outpatients, long-term health care hospitals, for inpatients of rehabilitation and psychiatric hospitals, critical access hospitals, nursing facilities specialized, medical, ambulance, laboratory, home health, hospice, and durable medical equipment.  

Boost LLC has a team of internal and external experts to develop a set of Medicare documentation services, Medicare audit services, Medicare consulting, and more to help our clients manage through the process and develop strategies for both business and legal appeal.  We offer end-to-end products and specialized services for all Medicare and Medicaid needs in terms of reducing operating costs, improving delivery and quality of care, and increasing front-line revenues with a strong emphasis on regulatory compliance. 

At Boost LLC, we have a unique position to offer end-to-end Medicare Audit Services and solutions that allow organizations to improve operational efficiency, drive innovation and embrace next-generation delivery models through digital technologies.