Medicare Audits in Long-Term Care: A Guide to MACs, RACs, and ZPICs

Cutting-edge strategies to prepare and respond to Medicare audits

Know what to expect during a long-term care Medicare audit
The book Medicare Audits in Long-Term Care: A Guide to MACs, RACs, and ZPICs describes the different types of Medicare audits that nursing homes face and helps you take a proactive approach to audit preparedness. You also receive detailed descriptions of what you can expect during the different types of Medicare audits, how to conduct an internal audit, specific ways to prepare for an audit, and what to do once you have been audited.

This resource helps you:

• Gain a comprehensive understanding of the agencies responsible for conducting Medicare audits
• Grasp the processes and steps an auditor takes so you know what to expect and can be prepared
• Conduct an internal audit with the internal audit checklists provided
• Learn specific risk areas and vulnerabilities that may be present in your facility
• Understand where to focus internal efforts and controls as is relates to compliance

Take a look at the Table of Contents

Chapter 1 - Medicare Oversight of Skilled Nursing Facilities
Chapter 2 - Medical Review Audits
Chapter 3 - Recovery Audit Contractor Audits
Chapter 4 - Benefit Integrity Audits
Chapter 5 - Comprehensive Error Rate Testing Program
Chapter 6 - Department of Health and Human Services / Office of Inspector General
Chapter 7 - Medicare Advantage Plans
Chapter 8 - Audit Case Examples
Chapter 9 - Preparing your Facility for an Audit
Chapter 10 - Post Audit Processes
Tools & Checklists

About the author:

Wayne van Halem, AHFI, CFE, President, The van Halem Group, has worked in various leadership roles at multiple Medicare contractors. Throughout his tenure, he served as a Fraud Analyst, Medicare Fraud Information Specialist, Investigator, Supervisor, Appeals Manager, and Consultant. He is an Accredited Healthcare Fraud Investigator and a Certified Fraud Examiner.

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