From the Editor: Surviving a Medicare Audit

  Hearing the word audit can strike us all differently at various times. Our Revenue Integrity department routinely audits our E&M visits, making sure that if they read our documentation, they will not only find the reason for an E&M charge, but also that they will arrive at the same level. We, as most hospitals, routinely audit charts for appropriate documentation of pressure ulcers. Program Directors are used to getting reports outlining their expenses versus their revenues and auditing those figures against the budget. These reports are all very routine and likely low on the anxiety scale.

  But what if you get a friendly letter from the IRS that your income taxes are to be audited? Despite the fact that you are honest and forthright when filing your taxes, it still strikes fear to the core of your being. Innocent errors on the tax form that the Federal Government has us fill out every year are not so innocent in their eyes. Understanding tax laws is the responsibility of the filer. A similar gut reaction would occur if any of us were notified of a Medicare audit. We all do the best we can to understand and practice within the guidelines (albeit difficult at times) from CMS, but often the interpretation of those guidelines is confusing. But like the tax laws, we are expected to understand the intent of the Medicare guidelines and practice within them. This need to understand is what brings so many out to the Wound Clinic Business meetings presented by Kathleen Schaum and Andrea Clark. And why Kathleen’s pre-and post-conference reimbursement workshops are packed, and always run overtime. Providers want to know!

  So in this issue, we have Andrea and Kathleen discussing the important topics of Surviving a Medicare Audit, and the top errors that tend to occur. Then read first hand experience from Desmond Bell, DPM, on the audit that he did survive!

  In the Challenges section, you will find another thought provoking article by Tom Serena, MD about the problem with the prevalent “divide” between wound care provided in the hospital and that provided in the Wound Clinic. I can’t imagine not being very tied into our hospital. One of our goals with our patients is to do all we can to keep them out of the hospital and out of the Emergency Room, but that is not always possible. Having our Medical Director and his nurse practitioner seeing patients in the hospital provides a vital continuity of care. The hospital physician’s ability to see our notes in the computer also provides some missing links to what has happened historically with the wound. When we admit patients, we send copies of notes and photographs of the wound(s) so that all can see, and perhaps prevent multiple removals of the dressings, as well as providing information of presence on admission. Additionally, our link to the patient often facilitates earlier discharge.

  On a lighter note, you will find the Clinic Report on antimicrobial dressings, as well as the Product Roundup section featuring HBOT solutions.

  It’s hard to believe that fall is fast approaching, and I hope to see many of you at the SAWC Fall meeting October 13-15 at the beautiful Rio All Suite Hotel in Las Vegas! We have a new track at this meeting totally dedicated to topics of interest to Wound Centers. For more information, go to https://sawcfall.com. We hope to see you there!

Dot Weir, RN, CWON, CWS, Co-Editor of TWC, Dorothy.Weir@HCAhealthcare.com