Medicare Reimbursement Audit Checklist

Has your client received an audit request from a Medicare contractor? Prepared by K&L Gates partner Stephen Bittinger, this checklist summarizes the primary types of Medicare reimbursement audits and how to respond to each. rely on this checklist to successfully navigate the audit process, whether it’s a pre- or post-payment review; conducted by a MAC or RAC; or a CERT, OIG, TPE, or UPIC audit.

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• Medicare Fundamentals
  Review this practice note from Practical Guidance – Healthcare to understand the general framework of the Medicare program. Health lawyers, get up to speed on Medicare’s requirements and waivers, reimbursement systems and concepts, and changes to the program following passage of the Affordable Care Act (ACA).
• Peer Review Organizations and Medicare Reimbursement Audits
  Learn how Peer Review Organizations (PROs), which monitor the quality and appropriateness of care under the Medicare program, ensure that services to Medicare beneficiaries are reasonable and medically necessary, meet professionally recognized standards of care, and are provided effectively and economically.
• Transparency in Coverage, No Surprises Act, and Consolidated Appropriations Act, 2021, Requirements Checklist
  Consult this checklist to stay in compliance with these three sets of rules governing patient disclosures (e.g., requiring publication of rates for covered items and services) and patient protections (e.g., prohibiting certain types of balance billing and provider-insurer agreements to restrict access to care).

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