01 Nov 2022
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.
Related Content
- 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).
Practical Guidance Updates
Featuring the latest updates from your Practical Guidance account.
- The Practical Guidance Journal Fall Edition features impacts of the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, 142 S. Ct. 2228 (June 24, 2022), on employers, healthcare, insurance, and privacy concerns, and tracks the status of state law changes.
- Legal Developments provide the latest updates and analyses of emerging topics impacting healthcare. Visit the Legal Developments page to see breaking healthcare legal news—notably on the U.S. Supreme Court’s Dobbs decision—and related Practical Guidance content.
- Listen Up! The Practical Guidance Podcast features interviews with industry-leading attorneys on cutting edge issues in the law: NFTs, Cannabis, COVID-19, and more. Catch the most recent episode on the podcast platform of your choice.
- Check out the new Practical Guidance Author Center! Learn about the 1500+ leading attorney authors contributing to our 22 practice areas, and find out how you can Become a Practical Guidance Author.
- Document alerts allow you to stay current on legal developments that affect your practice. Find out how to set up your document alerts.
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