Medicare Audit Documentation

In Medicare Audit Documentation, pharmacists and other pharmacy staff learn to interpret and respond to Medicare Part B audit letters. Topics covered include:

• Types of documentation requested in a typical audit letter: Detailed written order (prescription), progress notes, proof of delivery, testing logs, assignment of benefits (AOB) form, refill request authorization, patient training confirmation
• Additional types of documentation needed for special situations: Advance Beneficiary Notice(ABN), and Certificate of Medical Necessity (CMN)
• Four main auditor groups designated by CMS: CERT, RAC, MR, ZPIC

Audit processes are carefully explained, as well as the need for keeping careful, accurate, and complete records of all Medicare transactions with beneficiaries. Pharmacy staff learn how to anticipate documents required in possible audits and which actions - or lack of actions - typically trigger an audit.

Later lessons present the four government-mandated auditing organizations and the specific focus for which each is responsible. Consequences of not responding to audits promptly and accurately are discussed, as well as the pharmacy's recourse in contesting audit decisions.

Each lesson contains quick self-checks to determine the participant's progress through the material. Participants take a final assessment to demonstrate their mastery of course content.

Learning Objectives

By the end of this course, participants will be able to:

• Identify and supply the information requested in audit letters
• Identify the documentation required to be kept at the pharmacy
• Identify additional documentation that may be required and when it applies
• Differentiate the auditing organizations that may request documentation from the pharmacy

Authors

Emdeon Recovery Team

Accreditation

LearnSomething, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

CE Requirements

To earn 1.0 contact hour or 0.1 CEUs of credit for Medicare Audit Documentation, you must complete the course, earn a score of 70% or better on the online Medicare Audit Documentation CE Mastery Exam, and complete the course evaluation.
Upon successful completion, participants will be able to access and print their Statements of Credit online.
Completion of this course by itself does not meet all the ACPE requirements for CE credit. Learners who desire a 1-hour ACPE Statement of Credit for Medicare Audit Documentation must also complete the CE Mastery Exam and Evaluation which are not included in this course.

Publication Information

ACPE UAN:

• Pharmacists: 0296-9999-11-005-H03-P
• Pharmacy Technicians: 0296-9999-11-005-H03-T

Credit:

• 1.0 Contact Hour
• 0.1 CEUs

Release Date: August 27, 2011
Expiration Date: August 27, 2014. Absolutely no credit granted if answers are received after this date.
Activity Type: Knowledge-based
Target Audience: Pharmacists and Pharmacy Technicians.

Disclaimer

This WBT was current at the time it was uploaded onto the web. It was prepared as a tool to assist providers and is not intended to grant rights or impose obligations. Although every reasonable effort has been made to ensure the accuracy of the information in this presentation, the ultimate responsibility for the correct response to any documentation request lies with the provider of services. Emdeon employees, agents, and staff make no representation, warranty, or guarantee that this compilation of Medicare information is error-free and will bear no responsibility or liability for the results or consequences of the use of this WBT. 

System Requirements

The Acrobat Reader is required to view many resources.


The Flash plug-in is required to view this course.

• Windows XP/ Vista/ Windows 7
• Processor: 800 MHz or higher for Windows XP / 1 GHz or higher for Windows Vista or Windows 7
• Internet connection: Internet functionality requires dial-up or broadband Internet access
• Internet Explorer 6.0 or greater
• Flash 8.0 or greater

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