Auditors follow one line: every dollar billed should trace to a service that was authorized, delivered, documented, and reconciled to a deposit. Keep records that connect those dots as you go, and an audit becomes pulling files you already have.
Program-integrity reviews aren’t looking for beautiful books — they’re testing whether billed care was real, authorized, and delivered. That means they trace a claim back to the visit note, the authorization, the caregiver, and forward to the payment and deposit.
The agencies that sail through audits don’t scramble — they close the books monthly, reconcile bank and payer activity, and keep documentation linked to the claim it supports. Retention rules vary by program and state (often several years), so store records so they’re findable, not just kept.
The most common — and most expensive — finding is billing that can’t be tied back to documentation. That leads to recoupment: repaying the disputed amounts, sometimes with interest, plus closer scrutiny next time.
NavSuccess does this for home care & healthcare agencies — see Bookkeeping for home care.
State Medicaid/DHS program-integrity units and their contractors; for Medicare, the MACs and CMS contractors. All follow the same billed-to-documented-to-paid logic.
Look-back periods vary by program and state and can span several years — which is exactly why consistent monthly records and proper retention matter.
Repaying amounts you billed that the auditor decides weren’t supported by documentation. It’s the most common audit outcome and the one clean records prevent.
Book a free 30-minute consultation. We’ll look at where your books and compliance stand and show you exactly what we’d take off your plate.