Why am I being audited?
- No documentation: The provider fails to comply with requests for medical records supporting the claim.
- Insufficient documentation: The medical documentation submitted is inadequate to support payment for the services billed.
- Medically unnecessary services: The medical records submitted and the services billed do not constitute medically necessary services based upon CMS coverage policies.
- Incorrect coding: The provider submits medical documentation supporting the service was performed by someone else, or overcoding the claims submitted
Learn more about the meaning and implication of each of these categories of errors from the
Society of Hospital Medicine.
Tip 1: Documentation, documentation, documentation
Tip 2: Assess your referral sources for compliance
Tip 3: Technology is your friend
Beyond tracking services rendered, home health agencies should explore the value of technology to ensure their caregivers are all compliant with state and federal training and licensing. Learn more about CareAcademy’s audit-ready reports.