How to Navigate a CMS audit – Ophthalmic Professional

In July 2011, the Centers for Medicare and Medicaid Services (CMS) introduced a Fraud Prevention Initiative. With this initiative, CMS aims to:

  • Keep individuals and companies that intend to defraud Medicare, Medicaid, and CHIP out of these programs.
  • Avoid payment of fraudulent claims when they are submitted.
  • Remove fraudulent individuals and companies from Federal health-care programs.

As a result of this initiative and others, providers and facilities may receive the dreaded “Dear Doctor” letter requesting documentation supporting claims for reimbursement. Don’t panic! Navigating an audit does not need to be onerous if you follow a few simple steps.

This article addresses the following topics:

  1. Determine who is performing the audit and the type of audit.
  2. Identify specific deadlines.
  3. Prepare and send complete information.
  4. Conduct an internal review.
  5. Understand your right to appeal.

This article was published in Ophthalmic Professional, and was written by Corcoran’s Vice-President, Donna McCune, CCS-P, COE, CPMA.To view the entire article in Ophthalmic Professional, click on the link below:

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