Medicare Compliance & Reimbursement

Question: I’ve heard of some federal or state agencies sending inspectors for unannounced audits or visits. If someone comes in saying they’re an inspector and need to see a provider because of a question about documentation, should I let them see the doctor?

New Jersey Subscriber

Answer: Depending on your role within your practice, ascertaining the credentials and purpose of a visit from an inspector probably isn’t your responsibility. In such a situation, you could show them to a private room, take down what information or identification they offer, and immediately contact your manager, your organization’s compliance officer, and your office of general counsel. They will be able to figure out who the inspector is and answer any questions.

Here are some federal and state agencies or contractors that you may need to know about:

• Centers for Medicare & Medicaid Services (CMS)
• Medicare Recovery Audit Contractor (RAC)
• Novitas, Palmetto, NGS, FCSO, Novitas, WPS, CGS: Medicare Administrative Contractors (MACs)
• New Jersey Medicaid/NJ Department of Human Services (or your state’s respective department)
• U.S. Office of Inspector General (OIG)
• U.S. Department of Justice (DOJ)

Rachel Dorrell, MA, MS, CPC-A, CPPM, Development Editor, AAPC