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Audits: Provide auditor with perfect package

Audits: Provide auditor with perfect package Q. What is the best way to organize documentation and respond to an audit?

A. The quality of your audit response packet is imperative. The objective is to put your company in the best possible light with the auditor, and provide them with organized and relevant documentation. The first step to having a well-organized audit response package is to understand what documentation the auditor is requesting. Read the entire letter from the auditor and make a checklist of the requested documentation. After that, add to your checklist by reading through the applicable national and local coverage determination requirements. Make sure your checklist includes each item necessary to prove medical necessity and any additional requirements from the Medicare Program Integrity Manual or Supplier Manual.  

Once you create your checklist, determine which paperwork from the patient's file you will send to the auditor. Do not send unnecessary documentation. Some suppliers make a copy of every piece of paper in the patient's file and send it to the auditor. Bad idea—this creates confusion for the auditor, but it also places you at risk of sending unflattering or damaging documentation to Medicare. Look over each document. Always check the dates and signatures on your dispensing and detailed orders from the physician to confirm the orders meet Medicare requirements. Read the medical documentation and ensure that it supports the patient's use of the product.

Finally, guide the auditor through your documentation by creating a cover letter to send with your packet. Explain each document enclosed in your response packet and how the document meets the Medicare requirements. Label your documentation and make it easy for the auditor to find each piece of paperwork in your packet. The key is to make it simple for the auditor to review the documentation and pay the claim.

Jillian Longo is a consultant with Harrington Management Group, LLC. Reach her at [email protected] or 888-833-3478.


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