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Are You Ready for a CMS Site Visit?


Whether you are a new provider or you have been in practice for some time, the Centers for Medicare & Medicaid Services (CMS) may pay enrolled providers a visit for a medical record review and audit.

Would you be prepared if this audit were to happen next week?

The goal of CMS onsite audits is to find any fraud or abuse in the healthcare payment system. Some insurance payers are now joining in on-site audit visits. During the visit, CMS will make sure that your physical address matches the address on your electronic records and that your business is clearly labeled with street and number signs. They will also check that the proper licensed staff is providing professional services and that medical records are unaltered.

Checklist To Prepare for CMS Onsite Visit

You will receive a warning letter from CMS or from an insurance payer announcing your site visit. An unannounced visit may occur as well. Take action right away:

  • Check the credentials and photo ID of the auditors.

  • Let your attorney know about the audit and ask if they have any preparation advice or if they want to be present.

  • You may request that the appointment be rescheduled to a less busy time for your office.

  • Determine the exact purpose of the office visit and what issues they have observed in other providers.

  • Ask in advance whether any of your staff will be interviewed. If yes, brief them on how to answer questions accurately – but don’t volunteer any additional information.

  • Prepare a secure room in which the auditors can work.

If the audit is for only for medical records, ask for a patient list in advance.

Keep copies of all material that you supply to the auditors.

As a good practice drill for your staff, do a self-audit. Make sure that HIPAA standards are being met and that certificates are properly displayed. While you are at it, include safety standards in your audit for both OSHA and health department standards.

The auditors are only doing their jobs! Healthcare providers and suppliers must have policies and procedures in place for full compliance. When you are prepared for an audit at any time, you and your staff are confident that all proper HIPAA and other mandates are in place.

Let Us Manage All Your Payer Enrollment and Credentialing Services

If you require medical credentialing and payer enrollment needs for your practice or medical facility, please contact 1st Assistant. Our experienced and dedicated specialists will provide all credentialing and enrollment services quickly and will monitor your account for ongoing updates and re-attestations. Heidi Henderson, Vice President of Credentialing, is eager to meet you and discuss your payer enrollment needs. Please call us at 512.201.2668 or contact us via the website.

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