What Orthopaedic Surgeons Should Know about Medicare Audits in 2023

Matthew Twetten, MA, MHCDS
Karen Zupko and Associates, Inc.

In the September 2023 AAOS Now practice management article, “What Orthopaedic Surgeons Should Know about Medicare Audits in 2023,” Matthew Twetten, MA, MHCDS, outlines key updates and considerations related to Medicare claims audits. The article explains why audit activity remains a significant compliance risk for orthopaedic practices and highlights how Medicare’s program integrity efforts are designed to identify improper payments, fraud, waste, and abuse.

The article reviews the various types of Medicare audit contractors, including Medicare Administrative Contractors (MACs), Recovery Audit Contractors (RACs), CERT contractors, ZPICs, PSCs, and Supplemental Medical Review Contractors (SMRCs), and explains how each conducts reviews and requests documentation. It also clarifies how audit targets are established, including the role of CMS and the HHS Office of Inspector General, and identifies areas of heightened scrutiny such as trauma claims, evaluation and management services, and telehealth.

This article provides valuable context for orthopaedic practices seeking to understand the Medicare audit landscape and reinforces the importance of proactive compliance, accurate documentation, and regular internal review to reduce audit risk.

Read the full article on AAOS Now: