Medicare and Medicaid Audit: Adult and Ped. Rheumatology Clinic Paper Example

Introduction

Over the last few years, the Centers for Medicaid and Medicare Services (CMS) have been enormously working harder and devoting considerable resources to program integrity or in other words to crack down on abuse, fraud and waste, implying that many of the healthcare centers and clinics are more likely than before to get numerous Medicaid and Medicare audits. The audits can adequately be described as intensive evaluations of the services that every medical provider has billed CMS for, the relevant documents concerning these inquiries as well as the general billing practices (Kurusz, 2015). As a result, it is a prominent role for the providers always to be ready and ensure they prepare thoroughly for the audit processes by the CMS to ensure that they increase the opportunities for a positive or excellent outcome in case an audit occurs (Butcher, 2010). Therefore, the chief objective of this paper is to highlight some of the significant steps and procedures I would undertake as a manager at Adult and Ped Rheumatology Clinic in preparation for a practice audit of our records of the first six months of the year 2018. The paper will include both the administrative and facilities support I would offer to the auditing team members as well as how I would ensure that my business office staff and other staff are all well prepared for a successful outcome and ensure that the audit process is accomplished more smoothly.

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How to Prepare To Give Administrative and Facilities Support to This Audit Team

Upon receiving a notification letter from the CMS regarding a Medicare and Medicaid audit, the initial step would be to respond and schedule the audit time and dates within the two weeks before the audit. Responding to the letter immediately is a vital administrative task that would assist me in planning the review and ensuring the schedule sticks to avoid inconveniencing the team conducting the audit. Also, before the actual date for the inspection, one of the substantial things to do is to keep the records documentation to facilitate quick access during the audit (Kurusz, 2015). A considerable step to accomplish this would be to create a system; for example, a spreadsheet for tracking multiple documents requests at a time (Butcher, 2010). I would also familiarize myself with the Medicare and Medicaid compliance manuals and regulations and ensure that all the records that require specific signatures are signed on a timely basis by the respective authority. Another task I would pursue to offer administrative support to the audit team is to perform internal or self-audit regularly with the help of my official staff. This will, however, ensure proper documentation and rectifications done on some of the mistakes made in Medicare and Medicaid payments in the first six months of last year, which will in turn ease and save time in solving any issues that the auditor uncovers.

Regarding the facilities support, I would ensure that adequate photocopying facilities are available at the clinic in case a need arises for the Medicaid auditors to scan and copy certain records for further investigation instead of giving them the originals, which may never come back. Also, as the manager of the facility, I would select a team of dedicated employees to act as an audit team and offer them training about the audit process and best communication skills that would help them to deal effectively with the auditors and their requests and thus keeping the process well-run and efficient (Snyder, Kaye & Mention,2017). In an incident where the auditors requests for both an entrance and exit conference where they would typically clarify on the records they need, the tasks they are going to perform and explain the final results of their audit, I would take them up on this offer by providing to them one room at the facility to hold the meeting. This would also hugely assist in reducing the work for my audit team as well as the auditors, clearing up any misunderstandings that may have taken place and have an idea of what the auditors might have included in the final report.

Preparing My Business Office Staff and Other Staff

One of the most effective steps to undertake before the audit is to prepare and educate both my business office staff and others within the clinic facility to ensure they profoundly understand the implication and the significance of the Medicaid and Medicaid audit (Snyder, Kaye & Mention, 2017). In so doing, it will help the physicians to appropriately utilize their time without complaining about the auditor having a second thought on serving patients covered by Medicare and Medicaid. To achieve this, I would set one of the working days to hold a seminar or training about Medicare audit. Enlightening my staff on this will keep them informed and by recording such pieces of training on a book will accurately demonstrate the seriousness of the clinic on the matter to the CMS. In the process of preparing the staff, I would also encourage them to maintain a high level of professionalism during the audit dates and remind them not to discuss any issues or cases regarding the patients. However, since the time available to respond to the auditors' inquiries is often limited and non-negotiable, the staff's time and effort are maximally used preparing for the response.

Additionally, having a copy of the compliance manual and documentation of employee training are essential weapons that substantially help the healthcare providers to increase the chances of high ranking and excellent results if a Medicaid audit occurs (Butcher, 2010). Maintaining documentation or evidence of the ongoing staff training and how the clinic achieves a meaningful use of the Medicaid and Medicare services has always been my primary objective which in turn acts as a significant defense in an audit. Having a copy of a compliance manual also ensures that my facility is always on the lead in complying with the CMS requirements consistently. Therefore, when asked by the auditing team to present to them the employee training documentation and a compliance manual copy, I would quickly respond to their request by retrieving the documents that I routinely store in one centralized location to accurately support my attestations.

Often at the end of a Medicaid audit, the auditing team handles over a written report explaining the outcomes from the audit (Butcher, 2010). The most important thing to do after receiving the report would be to address the issues pointed out by the auditors as the significant problems such as problems with documentation and billing. Discussing the auditing findings is essential primarily because it helps to prevent the concerns raised from occurring again in the following audit.

Conclusion

In conclusion, every Medicare provider facility is different, and thus the audit process often differs. However, it is always crucial to adequately prepare for an audit by mostly following the compliance manual and offering training to the staff members while documenting the steps undertaken for higher chances of good audit outcomes.

References

Butcher, L. (2010). How to Prepare Now for Medicare, Medicaid Audits. Neurology Today, 10(8), 20-21.

Kurusz, S. (2015). Medicare and Medicaid audits. Bulletinonline.

Snyder, A., Kaye, N., & Mention, N. (2017). Managed care for Medicaid dental services: insights from Kentucky. Available at:)(Accessed June 27, 2017) http://www. nashp. org/wp-content/uploads/2016/04/Managed-Care-Brief. pdf View in Article.