Hospital administrators, physicians, and members of every healthcare office billing department know that if their practice or hospital provides services to Medicare patients, they must be prepared to potentially receive a request for an audit.

1. How To Prepare For A Medicare Audit

2. Call us at: 302-261-9187
Email us at: richard.smith@medisysdata.com
How To Prepare For A Medicare Audit
Hospital administrators, physicians, and members of every healthcare office billing department know that if their
practice or hospital provides services to Medicare patients, they must be prepared to potentially receive a request for an
audit. The Centers for Medicare and Medicaid Services (CMS) is responsible for devising the audit strategy and enforcing
it on a year-to-year basis. Medicare audit process may seem overwhelming, but becoming familiar with the process will
allow your organization to be prepared if an audit does occur. CMS also provides documents online to help you further
understand the process in more detail. To help prepare you to deal with this likely occurrence, we shared guidance for
compliant documentation and timely response to auditors. When you are prepared for Medicare audit, it can ease the
audit discomfort and enable you to focus on caring for patients.
Responding to an Audit Request
Once you have gathered all the paperwork needed to support your claim, make two sets of copies of everything you are
sending. Keep one set for yourself, so you know exactly what each packet contained. Follow these guidelines for
assembling and submitting your responses:
• Include a cover letter explaining that you are replying to their request. Include in the cover letter the telephone
number auditors should use to contact you or your representative if any questions arise.
• Next include a copy of the ADR as the first sheet in each packet.

3. Call us at: 302-261-9187
Email us at: richard.smith@medisysdata.com
How To Prepare For A Medicare Audit
• Write an individual summary of each record, detailing the medical issues addressed in your documents; include the
patient’s name, date of birth, HIC number, medical condition, prescribers’ names, etc., and discuss what will be found
in the enclosed documents.
• If anything in the ADR is not included, mention that in the written summary. For example, if physician documentation
doesn’t arrive in a timely manner, note that physician documentation is lacking but will be forwarded when it
becomes available.
• Assemble the documents in the order listed on the ADR, and put each file in the same order.
• Pack into an appropriate box with a list of all records contained in each box.
• Keep copies of everything sent.
• Send via any method of return receipt to ensure delivery at least one day before your deadline.
Prepare for a Medicare Audit
• Most CMS notifications arrive by mail, so make sure your front office knows what to do with these letters when
they’re received. CMS only allows a window of 45 days to respond, so time is of the essence and unpaid claims may
be the result of missing the deadline.
• A Medicare audit is not something to take lightly and everyone in your staff must understand how important it is to
comply accordingly.
• CMS will notify about the submissions under review and supporting documents are needed. Select team members to
run point on this to streamline communication within the office and with the Medicare contractor.

4. Call us at: 302-261-9187
Email us at: richard.smith@medisysdata.com
How To Prepare For A Medicare Audit
• If you’ve been audited by CMS previously, review those audits. Make sure your staff took the proper steps to rectify
the problems that triggered the previous audits. Medicare can look at claims as old as four years, so review as many
claims as possible and look for mistakes. If you have a plan in place to correct the mistakes you discovered, it will save
time during the audit.
• When gathering the necessary documentation for audit resolution, ensure complete prescriber medical records.
Organizing and storing complete documentation can be time consuming but essential.
• It’s always advisable to complete documentation at the time of service than try to piece the puzzle together at the
time of an audit, which could potentially occur years after the claim has been paid. Medical records must specify
each patient’s diagnosis and detail the medical necessity for the equipment.
• Your point person is critical in the auditing process, he or she must be knowledgeable and well-informed on Medicare
billing practices and your own internal billing systems.
A Medicare audit is not something that should be taken lightly, but it can be prepared for ahead of time by instituting
best practices. By knowing what errors are most common, you and your staff can determine which areas you are already
proficient in and which areas may need improvement. When it comes to a Medicare audit, being prepared and ahead of
the curve is always the best course of action.

5. Call us at: 302-261-9187
Email us at: richard.smith@medisysdata.com
How To Prepare For A Medicare Audit
Medisys Data Solutions is a leading medical billing company providing complete assistance in medical billing and coding.
By implementing processes that follow CMS regulatory guidelines for Medicare, your healthcare organization can be
confident in your ability to weather an audit. To know more about our billing and coding services, contact us at
info@medisysdata.com/ 302-261-9187.

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