Medicare Audits
Sara Beck
Description
Collection
Title:
Medicare Audits
Creator:
Sara Beck
Date:
3/18/2013
Text:
Hi List,
I want to give some encouragement to providers fighting Medicare
audits and appeals. Beginning early last
year, my office recieved 27 post payment audits (over $120,000), all relating to the
patients functional level. I have been able to get approximately 45% of them overturned so far. The rest are pending for and
Administrative Law Judge Hearing. All (100%)
of my appeals determined by an Administrative Law Judge have been
favorable. One of the key methods in
getting a favorable decision for a post-payment audit is to make sure that the
referring physician and prosthetist document that the patient was the specified
functional level at the time of service. Really, that is all that is needed; as long as the other documentation
(delivery acknowledgement, prescription, etc.) is sufficient. During the first two levels of appeals, it is
like pulling teeth to receive a favorable decision; even if the documentation
is more than sufficient. So, don’t get
discouraged. Once you get to the
Administrative Law stage, it’s pretty much common sense. All judges put
substance over form. Meaning, they will
look at the reasonableness of the services and determine a just result. If the patient needed the item at the time of
service=favorable. It has been that
simple.
As far as pre-payment audits, Medicare is solely looking at
the physician notes; they look at nothing else. The physican notes must
contain an entire physical examination and must be extremely detailed. Basically,
they are requiring that the referring physician do the work of the prosthetist.
Obviously, we all know that this new requirement is unreasonable and
unrealistic, to say the least. In my opinion,
the key to all of this madness is to keep fighting. Fight every single audit you receive. Medicare purposefully makes the audit and
appeals process very complex and extremely time consuming, expecting providers
to just give up and hand over the money. Don’t do it. The more we fight, the more
progress will be made.
Also, contact your state legislation and give them real-life
examples of the devastating effects of these audits. Congress really has no clue as to the
destruction being caused.
If anyone has any questions, concerns or needs help, please
contact me. I am more than willing to help. Collaborative effort is the only thing
that will help find a solution to this mess.
Sara Beck
San Joaquin Orthotics & Prosthetics
I want to give some encouragement to providers fighting Medicare
audits and appeals. Beginning early last
year, my office recieved 27 post payment audits (over $120,000), all relating to the
patients functional level. I have been able to get approximately 45% of them overturned so far. The rest are pending for and
Administrative Law Judge Hearing. All (100%)
of my appeals determined by an Administrative Law Judge have been
favorable. One of the key methods in
getting a favorable decision for a post-payment audit is to make sure that the
referring physician and prosthetist document that the patient was the specified
functional level at the time of service. Really, that is all that is needed; as long as the other documentation
(delivery acknowledgement, prescription, etc.) is sufficient. During the first two levels of appeals, it is
like pulling teeth to receive a favorable decision; even if the documentation
is more than sufficient. So, don’t get
discouraged. Once you get to the
Administrative Law stage, it’s pretty much common sense. All judges put
substance over form. Meaning, they will
look at the reasonableness of the services and determine a just result. If the patient needed the item at the time of
service=favorable. It has been that
simple.
As far as pre-payment audits, Medicare is solely looking at
the physician notes; they look at nothing else. The physican notes must
contain an entire physical examination and must be extremely detailed. Basically,
they are requiring that the referring physician do the work of the prosthetist.
Obviously, we all know that this new requirement is unreasonable and
unrealistic, to say the least. In my opinion,
the key to all of this madness is to keep fighting. Fight every single audit you receive. Medicare purposefully makes the audit and
appeals process very complex and extremely time consuming, expecting providers
to just give up and hand over the money. Don’t do it. The more we fight, the more
progress will be made.
Also, contact your state legislation and give them real-life
examples of the devastating effects of these audits. Congress really has no clue as to the
destruction being caused.
If anyone has any questions, concerns or needs help, please
contact me. I am more than willing to help. Collaborative effort is the only thing
that will help find a solution to this mess.
Sara Beck
San Joaquin Orthotics & Prosthetics
Citation
Sara Beck, “Medicare Audits,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 23, 2024, https://library.drfop.org/items/show/234848.
