Billing Compliance Audits

Agencies often take for granted that a good survey by state or national licensing and certification entities mean their agency’s clinical records are also compliant with Medicare and Medicaid billing requirements.  Billing compliance auditing encompasses not simply program documentation requirements but compliance with Medicare and Medicaid Program Integrity regulations, Local Coverage Determinations for coverage and Medicare and Medicaid Billing regulations.   

Brooks*Acevedo consultants offer single chart reviews up to large scale billing compliance audits to help agencies assess their financial risk of overpayments. A billing compliance audit of records requested by a Medicare or Medicaid review contractor or investigator helps ensure that the documentation required for payment is properly submitted.  Often the best risk elimination is to have a billing compliance audit conducted at least annual on a sample of claims to ensure ongoing compliance. 

The Affordable Care Act provide hundreds of millions of additional dollars to combat fraudulent and improper billing of Medicare and Medicaid funds.  Providers striving to meet all regulatory and billing guidelines are often faced with large overpayments due to minor oversights in service documentation.  These unintentional oversights can lead to millions of dollars in overpayments through ZPIC and OIG investigations.  An agressive billing compliance program is the critical in today's heavily regulated environment. 

Brooks Acevedo Attorneys at Law

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