Q&A: Am I in trouble if my Medicare carrier has asked to see a patient's chart?

August 15, 2008

My Medicare carrier has requested a copy of the chart for one of my patients. Does this mean I'm going to be audited? Should I call my attorney?

Q: My Medicare carrier has requested a copy of the chart for one of my patients. Does this mean I'm going to be audited? Should I call my attorney?

A: Since the carrier has asked for only one chart, you may just be part of a random spot check. You can notify your attorney, but there's probably no reason for alarm. Before sending the chart, review it carefully to see if you spot anything about the patient's care that might have prompted the record request. Also include any additional documentation needed to support your claim. For instance, if a recent patient history refers to an earlier note, include that note. But don't revise a medical record in any way once it has been requested.

If the carrier asks for additional records, assume you're being audited and let your attorney know. Your attorney might want to have a coding expert review the charts before you send them to the carrier. But you should review them too, and look for any common denominators among them. That may help you and your attorney prepare to address the carrier's concerns.

Send your practice management questions to mepractice@advanstar.com (please include your regular postal address). Answers to our readers' questions were provided by Alice G. Gosfield, JD, Alice G. Gosfield and Associates, Philadelphia; and Virginia Martin, CPC, CHBC, VP of operations for Reed Medical Systems, Monroe, Michigan.