Medicare Advantage Audits: Mounting an Effective Defense

Your organization has just been audited by a Medicare Advantage organization (MAO), and now you’re stuck with a costly claim denial. Will you contest it? Do you even have the right defense in place? Under pressure from CMS, MAOs have become more aggressive in their provider audits, looking for program noncompliance, potentially even fraud and abuse. But the fact is, many audit findings are simply wrong, and recoupments in these instances are not owed by providers. In other words, you must prepare to fight back.

By popular request, we’re bringing you this RACmonitor webcast, presented by Medicare and Medicaid litigation attorney Knicole Emanuel. Learn how Medicare Advantage rules contrast with the rules for traditional Medicare, as well as general legal defenses to deploy when audited. Armed with Knicole’s expert instruction and tips, you’ll be better positioned to ace an MAO audit and hold onto payments that are rightfully yours.

Why This Is Relevant:

For 2022 CMS has allocated an additional $50 million in its budget for provider audits — which means the odds of being targeted have gone up significantly. But don’t expect an MAO auditor to play by the same rules as a traditional Medicare audit entity. Through this RACmonitor webcast, you’ll become familiar with the unique aspects of a Medicare Advantage audit and learn how to defend yourself accordingly.

Learning Objectives:

• Become more familiar with Medicare Advantage and how it differs from traditional Medicare
• Understand what constitutes a Medicare Advantage audit
• Learn how to defend your organization in an MAO audit
• Recognize when extrapolation is allowed under Medicare Advantage-specific rules
• Get insider tips for acing an MAO audit

Who Should Attend:

Compliance officer; audit defense teams; denials and appeals coordinators; chief executive officer; chief financial officer; hospital officials; physicians; and staff from durable medical equipment companies, home health agencies and long-term care facilities.