Preparing Yourself To Get Through An Audit Unscathed
I wasn’t born and raised in Florida, but in the 15 years that I have called Jacksonville home, I have come to appreciate the charms and nuances of living in a beautiful subtropical climate where living near water brings with it natural beauty as well as the potential for disaster.
As most Floridians are keenly aware, hurricane season extends from June 1 until November 1. Fall is here and another hurricane season has nearly reached its conclusion, which means we are almost ready to breathe another collective “Sunshine State sigh of relief,” having gotten through another year unscathed.
However, there is another serious storm that is building, one that threatens the wound care world unlike anything we have seen to date.
Preparedness in readying for a hurricane can mean the difference between life and death. Readying yourself for an audit by the Centers for Medicare and Medicaid Services (CMS) or a recovery audit contractor (RAC) can mean the difference between your financial survival and the ability to continue delivering your infinitely valuable services to those in need. The key is to be proactive versus reactive.
If you do not think you will ever come under a pre-payment review or audit, whether due to the odds or your belief that you are innocent of any practice patterns that could be found as fraudulent, think again. Going through a Medicare pre-payment review a few years ago for the primary sin of providing wound care services to homebound patients was an experience that is still tinged with bitterness.
One of the hats I wear is an editorial board member for Today’s Wound Clinic. In my opinion, the August 2012 edition of Today’s Wound Clinic is required reading and is the most important issue of the journal to date. You can also read about my experiences in a wound care pre-payment review that lasted over a year in the article titled, “Signs of an Impending Audit: Are You Waving Red Flags?” (see http://todayswoundclinic.com/articles/signs-impending-audit-are-you-wavi... )
The entire issue is dedicated to becoming proactive in surviving a wound care audit. Even if you provide wound care services as an adjunctive service of your general podiatric practice, do not think you are immune to financially incentivized RAC auditors whose sole mission is to recoup money from as far back as three years ago. Imagine going into a restaurant three years after eating a meal and demanding your money back, and having the federal government encouraging you to do so. It sounds preposterous but unfortunately, this is reality.
Please follow the links to several articles in the August edition of Today’s Wound Clinic or look for a copy if you work in a wound center that receives the journal. These articles will serve as important references in better understanding the issues, what is at stake, and how we may all be impacted.
As a colleague and friend, I can only wish you never end up in the crosshairs of a CMS or RAC audit of any kind and once again ask you to read the recommended articles in this issue sooner than later. The best way to deal with a bully is to punch him in the nose. Again, be proactive, not reactive.
Until next month, keep up the great work. Your efforts and results are truly priceless and those in need truly appreciate them.