If Medicare is conducting an audit, SOMETHING may NOT be coded correctly as you believe. Lets say the doctor was submitting his own claims, using his own coder and biller and now the coding and billing is being outsourced overseas.

These new people have changed the profile of the provider by undercoding, overcoding, and misusing modifiers. Appeals were also sent misusing modifiers. So now, Medicare says something with this doctor has changed and now they want to know what.

This is one reason why Medicare conducts audits. First it starts with asking for a few medical records, then if they find something, they ask for more and then if they confirm what they find, then they do a full blown audit going back many years.

Never say your coding and documentation is accurate. I've looked at many records where I have been told that only to show the people where they have errors. I just gave a group of students their final test and part of the test was to fill out the CMS 1500 form. They all said the form had no errors but every one had errors. No insurance address at the upper right of the form, no policy numbers, partial policy numbers, incorrect policy numbers. One patient wrote the patients name as Smith, Mrs. I saw missing NPI numbers, no linking of ICD-9 codes, wrong dates of service, accept assignment block was blank. The charge was $255 and I saw many have $225. Many checkmarked that there was no other insurance but they filled in blocks 9a-d. Blocks 31, 32, and 33 were left blank. Yet, everything they needed in all of the appropriate blocks was in the scenario.