tci Medicare Compliance & Reimbursement - 2021 Issue Q3

Reader Questions: Know These Facts on Non-Medicare Payer Audits

Question: We treat pediatric patients, so we don’t submit many Medicare claims, except in rare circumstances. Our new practice manager keeps asking us to create an audit preparation plan, but why should we worry about audits if we don’t really deal with Medicare? Texas Subscriber Answer: Medicare is not the only payer that performs audits of medical practices. You could also get audit requests from private payers, Tricare, or Medicaid. These non-Medicare insurers also audit documentation, medical necessity, coding, and billing as well. So even if your practice does not work with Medicare and Medicaid, it is...

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