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Billing Medicare or Medicaid? Understanding Your Audit Risk

Jenna Godlewski and Alice Harrs, for MaynardNexsen:

If you are a healthcare provider enrolled with Medicare and Medicaid, it is imperative that you know the governmental agencies’ expectations for compliant billing and understand that the agencies constantly monitor and audit provider claims to identify aberrant claims submissions and billing patterns.  This article summarizes several primary governmental agencies and Center for Medicare and Medicaid Services (“CMS”) contractors who conduct audits of healthcare claims reimbursed by Medicare and Medicaid and provides information as to how to monitor and identify the current audit targets of these auditors.