The Medicare Audit Process

The Medicare Audit Process

Medicare providers and supplies should expect audit contractors to attempt to identify improper payments resulting from:

·   Incorrect payment amounts;

·   Non-covered services (including services deemed medically unnecessary);

·   Incorrectly coded claims; and

·   Duplicate claims

The Medicare claims appeal process has several levels of appeal: redetermination, reconsideration, Administrative Law Judge, Medicare Appeals Council, and finally, judicial review.  There are different time periods and claims amount requirements for each of these levels, and adherence to these requirements is necessary.

Since 1983 we have been helping physicians to operate practices as a business, over 500 Medicare and Medicaid audits have given us the knowledge to develop the AccuChecker Product Line including Claims Scrubbers and for the 10 years we have been involved in HMOs Risk Management and have developed the MCAR Reports – Managed Care Reports.

For more details:

HPP Management Group, Corp.

Developers of the AccuChecker Product Line

Phone: (305) 227-2383

Email: support@accuchecker.com

Website: http://www.accuchecker.com

 

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