Home Health & Hospice Week

Nobody likes to go through Medicare audits, but knowing the ropes can save you precious time and even denied claims.

Here are four ways to stave off audits -- and when necessary, prepare for them -- that can help you get on the right track.

1. Keep up with Medicare regs. Home health agencies, hospices and durable medical equipment suppliers are often too busy to stay on top of all of their intermediaries' and carriers' many policy changes, which can spell trouble from a compliance standpoint. If you fail to keep up with your payer's requirements, you could be billing incorrectly, and you might end up being an audit target.

For example: During a recent recovery in Connecticut, three separate providers made identical errors that caused Medicare to accuse them of overbilling a particular service.

"It would be surprising to see the same deliberate fraudulent overbilling in three different provider systems, which leads me to believe there's a good chance that the rules changed and the [providers] just weren't aware of it," says attorney David C. Harlow of The Harlow Group in New-ton, MA.

2. Ensure your documentation is correct. In some cases, clinicians may not document properly to justify a claim. Clinicians often "are doing all of this work but fail to document the services they did," said Annette Grady, an independent healthcare advisor and instructor, during her recent Eli audioconference, Everything You Need to Know About Responding to a Chart Review. "The sad part about that is I knew the work was performed, but the documentation didn't support that the service was provided," she says.

"If you end up in an audit and you're trying to make excuses for documentation gaps, you're fighting a losing battle," Harlow says. "The goal is to have your documentation in good shape up front. It's not only complete documentation that you need -- it's also accurate documentation."

3. Find out why Medicare is auditing you. If an auditor contacts your organization and requests a meeting to discuss your records, ask why.

"It makes sense to try and get a handle on exactly what sort of information they may be looking for," Harlow says. "It is appropriate to ask "What is the scope of the audit you're doing? What are you looking for? Is this purely post-payment review, or is there another area that you're looking at?" Harlow advises. If there's a chance that your company is the target of a criminal investigation, you should ask your attorney to come to the audit, Harlow adds.

4. Keep a record of what the auditors review. "If the auditors take copies of your documentation, you should get a set of copies of the same materials so you know what they've taken with them to examine, whether it's paper or electronic copies," Harlow advises. "That way, you can huddle with advisors later to ensure that everything is complete and accurate."

If you find that any of the information the auditors took with them requires further explanation, "do so proactively, rather than waiting for them to ask," Harlow says.