Medical Record Audits

Orthopaedic surgeons are subject to three types of documentation audits:

Comprehensive Error Rate Testing (CERT) - The program is responsible for measuring improperly paid claims.

Recovery Audit Contractor (RAC) - The RACs detect and correct past improper payments so that CMS and Carriers, FIs, and MACs can implement actions to stop future improper payments. 

Zone Program Integrity Contractors (ZPIC) - Replaces the Medicare Program Safeguard Contractors (PSCs) and Medicare Drug Integrity Contractors (MEDICs) that are currently in use by CMS.  ZPICs are responsible for detection and deterrence of fraud, waste and abuse across all claim types. ZPICs have access to CMS National Claims History data, which can be used to look at the entire history of a patient's treatment no matter where claims were processed.

Determine the Type of Audit Request

Determine How to Respond to the Audit Request