AHLA Health Care Provider and Supplier Audits Practice Guide (AHLA Members)
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The U.S. Department of Health and Human Services' Center for Medicare and Medicaid Services (CMS) has used independent contractors to audit providers and suppliers for improper payments, and this use has increased exponentially over the last few years. It can often be difficult to determine if a contractor has exceeded its authority as not all Medicare contractor authority is publicly available, and CMS and the states haven't clearly identified where Medicaid contractors' authority is defined. Health Care Provider and Supplier Audits Practice Guide, First Edition is a useful guide to understanding the intricacies of the Medicare, Medicaid, and commercial payer regulatory environment.
• Introduction to audit contractor landscape
• Medicare Part A and B contractor audits
• Medicare Part C and D audits and appeals
• Medicaid audits
• Commercial payer overpayment disputes
Anyone who needs an understanding of Medicare, Medicaid, and commercial payer audits and overpayment demands will find Health Care Provider and Supplier Audits Practice Guide, First Edition a useful guide.
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Jessica L. Gustafson, and Abby Pendleton
Darby C. Allen, Lauren M. Gaffney, Anna M. Grizzle, Jessica L. Gustafson, Stephanie Fuller Johnson, B. Scott McBride, Sydney R. Nash, Abby Pendleton, and Sarah Kay Wheeler
Published February, 2016.
Table of Contents
Table of Contents
About The Editors
About The Authors
2 Medicare Part A and Part B Contractor Audits
3 Medicare Part C and Part D Audits and Appeals
4 Medicaid Audits
5 Commercial Payer Overpayment Disputes
Appendix A Unified Program Integrity Contract (UPIC) Uniform Statement of Work
Appendix B Statement of Work for Recovery Audit Program
Table of Cases
Table of Statutes