How do I survive a payer or Medicare audit?
You survive an audit with documentation that matches what you billed — every code supported by a signed, dated note — and by responding on time, completely, and calmly through the defined appeal levels. Most adverse audit findings come down to documentation gaps, not fraud, and many overpayment demands are reduced or overturned on appeal.
What actually matters
- Respond by the deadline with a complete, organized records package — a missed or partial response is often an automatic loss
- Make sure every billed code is supported by documentation: signed, dated, legible, and matching the date of service
- Understand which audit it is (prepay, postpay, RAC, UPIC, commercial SIU) — the rules and appeal rights differ
- Appeal adverse findings through the levels; overpayment extrapolations in particular are frequently reduced
- Fix the root cause afterward — a documentation or coding pattern the audit found will recur if you don't
Common questions
Can you appeal a Medicare audit / overpayment demand?
Yes. Medicare has a five-level appeals process (redetermination, reconsideration, ALJ, Appeals Council, federal court). Extrapolated overpayments are often reduced when the sample or methodology is challenged.
Where Volari fits: Volari's appeals discipline is built to file only what's substantiated — the same principle that keeps a practice's record clean with its payers.
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