Audit Targets: Don't Be One!

Presenters & Locations:
Kelly Grahovac, The van Halem Group (Atlanta and Charlotte)
Pam Colbert, The van Halem Group (Nashville)

Presentation Overview:

Almost every Medicare audit has resulted from in-depth and innovative analysis of your claims data. There are certain internal processes, business models, codes, and billing practices that cause red flags and make providers the focus of intense and aggressive audits by government contractors that could result in significant administrative and financial penalties. This presentation will discuss some of the government's top triggers in the DMEPOS industry and why these actions are concerns to CMS and other government entities. Understanding the mindset of the oversight entities makes it possible for providers to employ appropriate internal controls to avoid unnecessary compliance issues and scrutiny.

Time will also be spent on an update of the current audit environment and its impact on suppliers. This will include a discussion on the current audit trends, upcoming changes that a supplier can anticipate in the regulatory environment, an update on current pending legislation to ease the burden on suppliers, and the status of pilot programs to reduce the ALJ backlog.