Medicare Audits

Medicare Audits

Jim DeWees

12/7/2012

Hello Everyone: I finally got my FIRST pre-payment audit!! Whoohoo... (sarcasm). I did make some exclamatory sounds when I got this letter, but it was not for joy at all... I delivered a BK prosthetic leg on Nov 21, transmitted the claim the same day. Medicare (well, actually NGS, actually Anthem) wasted NO time in sending this for the pre-payment audit. Fortunately, I do follow the rules precisely! The paper trail and treatment for this patient could not be more clear and perfect (which is true to all my patients since I learned about this process last February). He came to my office on Oct 25 with an Rx, got shrinkers. He came back on Nov 12 to be cast, and also I made sure he had an appt with his doctor for the medical evaluation by his physician set up. He came back on Nov 19 for the check socket fitting, AND he had been to his physician that morning for the evaluation. The surgeon had already faxed a copy of his chart notes to me so I can make sure they are good enough to pass an audit. He received his prosthetic leg on Nov 21 (I worked during the weekend so he could get his leg to show it off to all his family for Thanksgiving). Now, I got my first audit for this claim. Since I got my first one last week, I have gotten 2 more. EVERY Medicare claim for legs seem to be going straight to the audits. (There has been NO other event or any cause that would have triggered any audits, but I think they finally pulled up my number and started doing audits on me.) But fortunately, ALL of these patients have perfect chart notes, dates, and all documentation. I will be shocked if I do NOT pass these audits, and from everything I have checked over, I do not see any way there is anything missing or coming up short. BUT I also know that it sounds like it really doesn't matter, and in many cases there are people claiming that they also thought their paperwork was perfect and they were still denied. We will see.... BUT my question: HOW are people sending these in for the audits? They MUST be mailed to a PO box which is on the audit form. I am afraid to send them certified, because of a required signature for delivery, AND some mailrooms or PO boxes will NOT sign for their mail. WHAT is the best, safest way to send something to Medicare (National Government Services....which is physically located in the Anthem Blue Cross building, and the same PO box as Anthem....in Indianapolis, Indiana.)??? Please let me know if there have been any problems sending things certified, or requiring signatures, or what anyone has encountered with this. I need someway to KNOW that it was received, because we all know of the old trick...we did not receive it garbage. Thanks, Jim DeWees, CP