Table of contents

  1. What is a Medicare audit?
  2. How GPs become a subject of Medicare audit?
  3. Random Medicare audit via telephone interview.
  4. Random Medicare audit via correspondence or a visit. Peer review.
  5. Medicare audit due to suspicion of any areas of concern by Medicare.
  6. Examples of what can be seen as suspicious by Medicare.
  7. How to avoid being audited? (Nohow. Audits cannot be completely avoided)
  8. How to significantly minimise the risk of being audited? How GPs end up in jail?
  9. 23 or 36 or 44. Is there a ‘golden formula’ of ‘safe’ billing?
  10. Billing Medicare items for ‘Unrelated’ services.
  11. Number of patients seen. Does it matter?
  12. Consistently billing ‘favourite’ items in significant numbers.
  13. Care Plans, Assessments, Mental Health Plans – how many is too many?
  14. Care Plans and Mental Health Plans – wrong pattern.
  15. Home visits – wrong pattern.16. You have received the letter of the audit. What to do? (Don’t panic)
  16. The first response is the most important in dealing with the audit. How to produce the first response. 
  17. The first response did not work. What is next?
  18. Things got worse – you are in front of PSR (Professional Services Review). What to do and what not to do.
  19. Medicare proposed the ‘punishment’. It is not the end of the game. Your options.
  20. You have reached an agreement with Medicare. What is next? How to reduce the impact of the ‘penalty. 
  21. Where to find help? Indemnity insurance, consultants. What to expect from those people?