Medicare Audits: A Survival Guide for Skilled Nursing Facilities

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Medicare Audits: A Survival Guide for Skilled Nursing Facilities

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Medicare Audits: A Survival Guide for Skilled Nursing Facilities

Maureen McCarthy, RN, BS RAC-MT, CQP-MT

Reduce the fear of an impending audit and take a proactive approach to preparedness. Medicare Audits: A Survival Guide for Skilled Nursing Facilities provides detailed guidance on the various Medicare audits SNFs face. Author Maureen McCarthy, RN, BS RAC-MT, CQP-MT, breaks down RAC, MAC, and ZPIC audits; CERT reviews; and more. Detailed descriptions, case studies, and example scenarios provide readers with the tools to understand how to prepare for each phase of an audit and what to expect once the audit is over.

This book will help facilities:

  • Gain a comprehensive understanding of the agencies responsible for conducting Medicare audits
  • Grasp the processes and steps taken by auditors
  • Conduct an internal audit with the provided checklists
  • Learn their specific risk areas and vulnerabilities
  • Understand where to focus internal compliance efforts and controls


About the Author:

Maureen McCarthy, RN, BS RAC-MT, CQP-MT, is the president of Celtic Consulting, LLC, and the CEO and founder of Care Transitions, LLP, a care coordination service provider. McCarthy is also the creator of the McCarthy Method, a documentation improvement system for ADL coding. She has been a registered nurse for nearly 30 years with experience as an MDS coordinator, director of nursing, rehab director, and Medicare specialist. She is a recognized leader and expert in SNF clinical reimbursement.

McCarthy is dually certified in the resident assessment process by nationally recognized organizations and is a Master Teacher. She holds a degree in business management as well as a nursing degree and served as an expert witness for Murtha Cullina.


Published: October 2016

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: Case Studies and Scenarios
Chapter 9: Preparing Your Facility for an Audit 
Chapter 10: Post-Audit Processes