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Sneak Peek: Effective planning can relieve audit fatigue

Case Management Weekly, May 16, 2012

Case managers are already familiar with the Medicare Recovery Audit Program. In January, however, government Recovery Auditors began focusing on new territory—Medicaid claims.

CMS mandated the Medicaid audits under a provision of the Patient Protection and Affordable Care Act. Access the final rule published in the Federal Register.

The good news is that Medicaid audits are similar to Medicare audits, and case managers can prepare for them the same way.

The bad news is that the increasing number of audits is taking case managers away from the bedside, says June Stark, RN, BSN, M.Ed., director of case management and quality support services at Tufts Medical Center in Boston.

You can’t make these audits disappear, but you can help manage them by working with your organization’s Recovery Audit team and planning your new workload, says Stark.

This article is adapted from an article which originally appeared in the May Case Management Monthly published by HCPro, Inc.