Compliance & Audit Readiness
Be ready-Medicare/Medicaid, VA, and DOL/DEEOIC.
A 30-minute intake-to-billing scan with an operator-advisor. Zero prep required.
What We Do
Auditors focus on whether services are covered, documented and billed correctly. An Office of Inspector General (OIG) audit of a home health agency found that 20% of sampled claims were non-compliant due to unsupported codes, missing plan-of-care requirements and failure to meet skilled need criteria. The OIG recommended refunding overpayments and conducting internal audits.
To Stay Ready:
Understand audit types
Medicare audits include Targeted Probe & Educate (TPE), Recovery Audit Contractor (RAC) reviews, Unified Program Integrity Contractor (UPIC) investigations and Comprehensive Error Rate Testing (CERT). Each type looks at different aspects of documentation, billing patterns and potential fraud.
Prepare proactively
We recommend continual document review, internal audits, validation of medical necessity, cross-checking of codes and staff training.
Maintain essential documents
Face-to-face encounter notes (timely and signed), accurate OASIS assessments, detailed plans of care, homebound status justifications and visit notes are critical.
Respond effectively
When an audit notice arrives, assign a team leader, create a response timeline, gather documents systematically, conduct an internal review before submission and track all communications.
Specialized Program Requirements
For DEEOIC providers, authorization is not permanent-approvals must be renewed every six or twelve months. The physician’s letter must specify the level of care (skilled nursing, assistive personnel or home therapy), frequency and duration, conditions requiring care and evidence of a face-to-face examination. For VA home-care, services like meal preparation, bathing assistance and mobility support are delivered by trained aides supervised by registered nurses, and veterans continue to receive services as long as needed. We ensure your documentation meets these unique requirements.
- Document controls & coding discipline
- Audit prep & response workflows
- Coverage, medical necessity, POC checks
- DOL/DEEOIC renewal cadence
- Training & internal audits
Proven Results
Typical Client Outcomes:
- Reduce days in A/R by 15-30 days
- Lower denial rates from 12% to 3%
- Improve cash flow by $150K+ quarterly
- Eliminate billing bottlenecks
“Clean intake and handoffs finally stabilized our cash timing.”
— Placeholder Client
“KFA helped us reduce our A/R from 45 to 28 days and improved our cash flow by $180K in just one quarter.”
— Sarah Johnson, CFO, Mountain View Home Health
Complementary Services
Compliance & Audit Readiness works best when paired with our Revenue Cycle Management services to ensure clean claims and documentation. We also recommend our Operational Strategy work to build compliant processes.
For agencies dealing with complex regulatory requirements, our Technology Enablement services help you implement compliant systems and workflows.
A 30-minute intake-to-billing scan with an operator-advisor. Zero prep required.
30-minute scan; we’ll pinpoint high-value fixes.