Medical Auditing Practice Exam

What should a provider do if billing patterns are flagged by their MAC?

1. Ignore the flags and continue business as usual

2. Request an audit of the flagged claims

3. Change the coding system used in the practice

4. Reduce the number of claims submitted

The correct answer is: Request an audit of the flagged claims

When billing patterns are flagged by the Medicare Administrative Contractor (MAC), it is crucial for a provider to take proactive and responsible steps to address the concerns raised. Requesting an audit of the flagged claims is the most appropriate course of action. By initiating an audit, the provider can gain a clearer understanding of why the claims were flagged, assess compliance with coding guidelines, and ensure that all billing practices adhere to regulatory standards. An audit allows for a thorough review of the specific claims in question, helping identify any discrepancies or areas that may require correction. This process not only assists in rectifying any potential issues, but it also demonstrates the provider's commitment to transparency and accountability in their billing practices. Taking this action helps mitigate the risk of further scrutiny from regulatory entities, protects the financial integrity of the practice, and ultimately supports better patient care by ensuring that claims are both accurate and justified.