A Medicare audit notice does not wait for a physician practice to get organized. Medicare Administrative Contractors (MACs), Recovery Audit Contractors (RACs), and Unified Program Integrity Contractors (UPICs) each have independent authority to request records, and the response window runs from the date the contractor mails the letter, not the date the practice opens it. A practice that has not mapped where its records live, who signs for contractor mail, and when counsel takes over spends its earliest days hunting for paperwork instead of building a response. The checklist below runs twice: once before a notice arrives, and again on the day one does.
Mapping Where Records Live
Every claim under review traces back to documentation that can sit in more than one place: the electronic health record, the practice management or billing system, a scanned paper chart, or a billing company engaged to submit claims. Keep a current list of every system holding part of the clinical or billing record, who administers access, and how quickly each source can produce records on request. A Medicare reviewer treats the claim, not the system, as the unit of review, and a response built from one system while an order sits in another produces a gap the contractor reads as unsupported.
Where a third-party billing company prepares and submits claims, get a written description of what records it keeps, in what system, and how to request them on short notice. A notice addressed to the billing company's name, or a documentation request that depends on records the practice does not directly control, can cost days the response window does not provide.
Who Signs for Contractor Mail
Name a specific role, not whichever staff member happens to open the mail that day, responsible for receiving, date-stamping, and logging any correspondence from a MAC, a RAC, a Supplemental Medical Review Contractor (SMRC), or a UPIC. Write the designation into the practice's policies so it survives staff turnover, and route contractor correspondence to the practice administrator or physician owner the same day it arrives. The deadline runs from the date on the letter, not the date it is discovered, so mail sitting unopened narrows the time left to respond.
Signature, Credential, and Order Documentation
Keep two files current at all times: a signature log identifying each clinician's signature, including any electronic signature credential, in a form that matches how the name appears in the record, and a file of every clinician's active licensure and credentialing documentation. Where a signature is required by statute, regulation, or a coverage determination, Medicare's program integrity manual calls for a legible, identifiable signature on the order and service record behind the claim, and if a reviewer cannot resolve a missing or illegible one through a signature log or attestation, the claim is treated as unsupported.
Confirm, claim by claim and not only when a request arrives, that the order or referral behind the service is in the chart, dated, and attributed to the ordering provider. Confirm too that the documentation on file meets the applicable local coverage determination. A documentation gap found in a sample of claims can be projected across a practice's full claims universe under extrapolation, once Medicare determines there is a sustained or high level of payment error or that an earlier educational intervention failed to fix it, so a single missing order can carry weight well beyond the one claim it came from.
Preserving Records and Deciding When Counsel Steps In
The day a notice arrives, put a litigation hold in writing on any routine deletion, overwrite, or disposal of records, system logs, and correspondence tied to the claims identified, and send that hold to everyone with access to those systems. A gap created after the notice arrived is treated differently than one that existed before it.
Decide in advance, not while reading the letter, when correspondence is forwarded to counsel: the first notice, the documentation request, or a results letter proposing a recoupment. A practice's own cover letters and staff communications with the contractor can affect the record at the stage covered in Filing a Medicare Rebuttal Statement Before Recoupment Begins, so that decision belongs to counsel, not to whoever answers the letter first.
A records map, a signature log, and a litigation hold cost nothing to build before the letter arrives. Assembled afterward, all three cost time, the one resource the response window does not provide.
Why Early Legal Counsel Is Critical
It is critical that physician practices promptly retain experienced healthcare defense counsel upon receiving a Medicare audit notice, documentation request, or recoupment letter. Early legal intervention can protect the practice's rights, shape the documentation response before gaps harden into findings, avoid inadvertent admissions in communications with the contractor, and preserve the practice's rebuttal and appeal rights. Delaying representation can narrow the practice's options once the contractor has already drawn its conclusions.
How Health Law Alliance Can Help
Health Law Alliance has represented 2,500+ clients nationwide. If your practice has received a Medicare audit notice or documentation request, or wants its records, signature files, and litigation-hold procedures in place before one arrives, contact Health Law Alliance's Medicare audit defense attorneys for a free, confidential consultation.
