Open AccessThe Medicare Audit and Appeals Process: A Guide for Interventional Pain Practitioners
Author(s) -
Vicki Myckowiak
Publication year - 2009
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2009/12/665
Subject(s) - audit , medicine , appeal , medical record , health care , medical emergency , nursing , accounting , business , surgery , political science , economics , law , economic growth
Background: Health care is a highly regulated industry and interventional pain physicians(IPPs) are right in the government’s bull’s eye. Over the next few years, IPPs will find themselvesresponding to audit requests from Medicare. An IPP’s response to a Medicare record requestshould be tailored specifically to the type of request and the specific circumstances of the IPP.With so much at stake, IPPs should not underestimate the importance of an immediate andthoughtful response.Objectives: This article discusses 1) the various types of record requests used by Medicare, 2)the practical steps an IPP should take in response to a record request, 3) the Medicare appealsprocess, and, 4) the practical steps an IPP should take in connection with the appeals process.Discussion: IPPs should maintain an effective compliance program and ensure that medicalrecords are appropriately documented before any audit takes place. If a Medicare audit decisionis unfavorable, IPPs should understand the available appeals process and the steps that need tobe taken to win the appeal.Conclusion: With advance preparation and a considered response, IPPs can positively influence the outcome of a Medicare audit.Key words: Medicare audit, appeals process, interventional pain management, interventionalpain practitioners, Office of Inspector General (OIG), Comprehensive Error Rate Testing (CERT),Carrier Medical Review Program, Recovery Audit Contractor (RAC) audits