1. Member Sections

Audits

New Patient Visit: Three Years Is a Key - 12/03/2021

Centers for Medicare & Medicaid Services auditors have identified claims coded for “new patient” evaluation and management services that don’t fit the definition for new patient services. Be sure to avoid this coding error.

How to Respond to a Medicare Audit - 08/27/2021

TMA Practice E-Tips editors ran across this excellent checklist of “17 tips from a lawyer” on how to respond to a Medicare audit.

Why, What, and Who Keys to Recoupment-Proof Documentation - 03/30/2021

The lack of a signature on specific portions of an otherwise complete documentation is enough to warrant a Medicare payment recoupment. Here’s what the Centers for Medicare & Medicaid Services found in three Comprehensive Error Rate Testing reviews.

Can’t Say It Enough: Document, Document, Document - 08/11/2020

When Medicare delves into claims errors, one stands out: insufficient documentation.

Be On the Lookout for MIPS Audit Request - 06/25/2019

The Centers for Medicare & Medicaid Services has contracted with Guidehouse, a nationwide consulting firm, to audit physicians who participate in the Merit-Based Incentive Program, which is under the Quality Payment Program. If you submitted MIPS data for 2017 and/or 2018, you could receive a request for information via email or certified letter from Guidehouse.

Another Possible Audit, This Time for MIPS - 04/19/2018

You could receive a request in the future from the Centers for Medicare & Medicaid Services for an audit of your Merit-Based Incentive Payment System submissions.

CMS to Expand Audits, Education Targeted to Outliers - 09/13/2017

A new type of audit may be coming your way, as the Centers for Medicare & Medicaid Services puts a pilot claims review program into practice nationwide.

HIPAA Audit, Phase 2: Are You in Compliance? - 02/02/2017

The federal government has begun its Phase 2 HIPAA Audit Program. The program aims to assess compliance with a wide array of HIPAA Privacy, Security, and breach notification rules.

Use Correct Surgery Modifiers in Medicare Claims - 05/13/2016

Medicare auditors working under the Recovery Audit program have identified significant payment errors related to surgery. Be sure to bill correctly using these modifiers.