Audits can be nerve-wracking. Let’s face it, just the word audit can make all of us cringe. Honestly, there is no reason to be nervous. As long as you are familiar with the audit process and the purpose of the audit, you will be more comfortable and be able to get through the audit without having to consult your phsyician.

CMS released a video on youtube recently that can help providers prepare for and understand Medicare and Medicaid reviews, audits and investigations. The purpose of the video is to help providers understand and identify “program integrity.” The video is a learning tool for providers, including home health and hospice agencies, to hopefully improve “program integrity”


  • improving stewardship
  • reducing fraud, abuse, waste, and improper payments
  • paying claims

Check out CMS’s video on Medicare and Medicaid Reviews, audits, and investigations.

After viewing the video CMS hopes that the providers will be able to

  • define “program integrity”
  • differentiate between a review, audit, and investigation
  • describe the entities doing program integrity work
  • explain what goes on before, during, and after a “program integrity” project
  • illustrate possible outcomes
  • describe how to prepare for a review, audit, or investigation
  • list sources of guidance and referral

You should always be scanning the web and check out CMS’s resources. After all, they are the official authority on these things and its good to know what they are saying. After you have reviewed their information, a good idea would be to search for related articles and videos so you can get a good understanding of how other people have interpreted the info that CMS has delivered.

The more comfortable you are with the audit process, the more likely you are to successfully navigate an audit if it ever happens to you. Routinely review your understanding of the audit process so that when it happens, if it happens, you are ready for it.


Data Soft Logic products include features that can help home health and hospice agencies improve their program integrity.