Clinicians sometimes email me about Medicare audits that they are undergoing. Since nearly everyone is being audited on either hyperbaric oxygen therapy (HBOT), the use of “skin subs” – properly known as Cellular and/or tissue-based products (CTPs) — or debridement, a Medicare audit these days is no surprise. However, this is how the dialogue sometimes goes:
Me: Which kind of audit are you under?
Them: I don’t know.
Me: Have you checked the website of your MAC to see what materials they have posted about the topic?
Them: What’s a MAC?
Basic things to do if you get notified of a Medicare audit:
- Look at the notification letter to see what kind of Medicare audit it is (e.g. TPE, RAC, UPIC, ZPIC, etc. This is important because different audits have different levels of risk for repayment and require different responses)
- See what specific clinical area is the focus (e.g., “skin subs” or HBOT for diabetic foot ulcers)
- Go on the website of your Medicare Administrative Contractor (MAC) and use the search function to find out what they have posted about that topic
- NOTE HOW MANY DAYS YOU HAVE TO RESPOND
- Learn what you can about the type of audit (there are lots of resources and I will post links below)
- Immediately identify specific people in your practice or hospital that will help you respond (this might need to include a lawyer)
I decided that I would go on the websites of various MACs and find out what they are saying about various audits relevant to wound care and hyperbaric medicine. I am going to post the information by MAC in a series of blogs and hopefully get knowledgeable people to comment about the information. Sometimes the information provided by the MAC is helpful and sometimes it is not very helpful, but you still need to know what your MAC is saying.
Even if you are not being audited right now (which would make you in the minority), this information might help you think through the documentation that you need to have in your charts to survive an audit when it comes – and it will come.
For this first post, I will provide links to the basics. Next I will start posting information from specific MACs.
General Audit Information
- Podcast with Helen Gelly – “Getting your wound clinic through an audit”
- SMRC: “Lessons learned during recent SMRC audits”, Michael Crouch
- 4 part interview series with Kathleen Schaum (free)
- “Trends in wound care audits and denials” with Helen Gelly
- Letter to Novitas about my own TPE
- “Bad news on an HBOT audit
- “How to fail a Medicare audit without even trying – bad news from the WPS region”
- “Medicare documentation for HBOT” by Helen Gelly
Other Audit articles in Today’s Wound Clinic (2015 to recent)
- How Does Your Electronic Record Measure Up Under Audit? March 2023
- Medicare Administrative Contractors Are Audited and Auditing: Learn From the Results February 2023
- Called to the Principal’s Office: My Experience With a TPE Audit February 2022
- How to Develop a Recipe for a Medical Audit Tool November 2021
- Forming a Plan for the Dreaded, Inevitable Audit February 2021
- Have You Read Your Own Documentation Lately? January 2021
- Update on Medicare/Medicaid Audits in the Wake of COVID-19 June 2020
- Managing Today’s World of Audits June 2020
- Successfully Navigating Today’s World of CMS Audits October 2019
- Frequently Asked Questions Surrounding Medicare’s Targeted Probe and Educate Review Program May 2018
- Determining What’s Broken with Your Wound Clinic Reimbursement & Implementing Required Fixes April 2018
- Responding Appropriately to Governmental Inquiries Related to Healthcare Services & Reimbursement August 2016
- 4 Steps to Achieving Audit Success October 2015
- Will You Be Able to Keep Your Medicare Payment After An Audit? October 2015
- Why Audits Are Happening In Wound Care & How To (Maybe) Avoid Them October 2015
- Understanding the Post-Payment Review Process October 2015
- How to Prepare For Your Pending Audit October 2015