Nancy Klein
Networker
Hello All,
If CMS performs a RAC audit, or if your local Medicare contractor performs an audit using an outside TPE, do they focus only on the area that prompted the audit? Here is why I ask: I'm aware of an office that had a local Medicare carrier (WPS) audit performed thru their contracted TPE. They focused on signature rules of E/M charts. The office passed with flying colors. That said, the office bills incident-to and they don't follow all the rules. (example: a new plan of care (POC) initiated by the NPP). When the Medicare TPE is performing the audit, do they look at other areas of the notes that could be a violation (such as the incident-to rules) or do they just focus on the reason for performing the audit? If the auditor only asked for office notes on one DOS for a patient would they know what the original POC is and if the NPP was following it? If Incident-to isn't their audit focus would they ask for additional dates of service on a patient to check to see if the rules were being followed (again-thinking of the POC)?
Thank you in advance!!!
Nancy Klein
If CMS performs a RAC audit, or if your local Medicare contractor performs an audit using an outside TPE, do they focus only on the area that prompted the audit? Here is why I ask: I'm aware of an office that had a local Medicare carrier (WPS) audit performed thru their contracted TPE. They focused on signature rules of E/M charts. The office passed with flying colors. That said, the office bills incident-to and they don't follow all the rules. (example: a new plan of care (POC) initiated by the NPP). When the Medicare TPE is performing the audit, do they look at other areas of the notes that could be a violation (such as the incident-to rules) or do they just focus on the reason for performing the audit? If the auditor only asked for office notes on one DOS for a patient would they know what the original POC is and if the NPP was following it? If Incident-to isn't their audit focus would they ask for additional dates of service on a patient to check to see if the rules were being followed (again-thinking of the POC)?
Thank you in advance!!!
Nancy Klein