Description

Audit Denials: Surviving the CMS Audit and ADR Storm: 

A Leader’s Roadmap to Strong Documentation and Processes

December 16, 2025 12:00 - 1:00 PM

 In today’s highly scrutinized home health environment, CMS audits are no longer a question of if—but when. This essential session, led by a former CMS medical review nurse, pulls back the curtain on the audit process to give agency leaders the insider knowledge they need to stay compliant, confident, and prepared. Participants will gain a clear understanding of the types of CMS audits (TPE, UPIC, SMRC, RAC, and more), what triggers them, and what reviewers are truly looking for in medical records. Through real-world examples, attendees will learn how to identify high-risk areas, strengthen documentation, and implement proactive compliance strategies that minimize denials and repayment risk. This session goes beyond theory—it offers practical survival tactics, from how to respond effectively to documentation requests to how to communicate with auditors and lead your team through the process with transparency and control.  BONUS: Table of contents for submission of audits

You will leave this session with: 

• Tools and checklists to ensure your records withstand reviewer scrutiny. 
• Expert insights on how CMS reviewers interpret medical necessity and eligibility. 
• Confidence to respond, appeal, and recover successfully when under review.

Objectives: Learners will be able to:

• 1.) List the technical requirements for home health payment under Medicare
• 2.) Discuss how to best support medical necessity of nursing and therapy
• 3.) Organize a record for audit following the payment hierarchy for best success.

Speaker:

ANNETTE LEE, RN, MS, HCS-D, COS-C

Annette is a registered nurse, with a Master’s in Health Care Administration, practicing since 1990, with the majority of her nursing experience in home health and hospice. For over a decade she worked with the CMS Medicare Administrative Contractor where she provided review of, and education on home health and hospice reimbursement, coverage and documentation. Annette then founded “Provider Insights, Inc” out of a need in the industry to translate “Medicare-ese” into language agencies could understand and assists providers daily with audits, quality improvement and survey preparation. She marries together her experience in the “real world” and the inside knowledge of Medicare to ensure providers can meet the requirements of CMS, and ensure compliant, efficient operations. Annette presents and consults nationally on the Conditions of Participation, (COPs), Survey, OASIS, PDGM, audits, quality measures and documentation and coverage for both the home health and hospice benefits. Annette holds both the Certificate for OASIS Specialist-Clinical and the Home Care Coding Specialist-Diagnosis certification.