PECOS, Stark Law & Anti-Kickback
CMS Medicare Compliance Software for Medical Practices
Manage Medicare compliance requirements including PECOS enrollment, Stark Law and Anti-Kickback self-disclosures, billing compliance audits, and emergency preparedness documentation. Built for practices participating in Medicare and Medicaid programs.
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Why Medicare Compliance Matters
Medicare audits have increased 40% since 2023, driven by expanded Recovery Audit Contractor programs. Stark Law violations carry penalties of up to $24,000 per claim, and billing errors can trigger extrapolation that multiplies small errors into six-figure overpayment demands.
40%
Increase in Medicare audits since 2023
$24K
Per-claim Stark Law penalty
180 days
PECOS revalidation window
$11B+
Annual OIG recoveries from fraud
What GuardWell Covers
Everything you need to manage cms / medicare compliance in one platform.
PECOS Enrollment Tracking
Track provider enrollment status, revalidation dates, and credentialing across Medicare Administrative Contractors. Automated 180-day advance reminders.
Billing Compliance Audit
Structured audit checklists for coding accuracy, modifier usage, E/M documentation, and claims review processes. Document your internal audit program systematically.
Stark Law & Anti-Kickback
Track financial relationships, referral arrangements, and compensation structures for Stark Law compliance. Document Anti-Kickback safe harbor analyses for each arrangement.
Emergency Preparedness
CMS Conditions of Participation emergency preparedness requirements — emergency plan, policies & procedures, communication plan, and training/testing documentation.
How It Works
Get compliant in three straightforward steps.
Activate CMS module
Toggle on CMS/Medicare during onboarding. GuardWell generates PECOS, billing compliance, emergency preparedness, and Stark/AKS checklists for your practice.
Document & track
Enter PECOS enrollment dates, document financial relationships, complete billing audit checklists, and upload emergency preparedness plans.
Stay ahead of deadlines
Automated reminders for PECOS revalidation, annual billing audits, and emergency preparedness drills. Regulatory intelligence monitors CMS rule changes.
Frequently Asked Questions
Common questions about cms / medicare compliance.
Any practice that participates in Medicare, Medicaid, or CHIP should use the CMS module. This includes practices enrolled in PECOS, those with Medicare provider numbers, and Federally Qualified Health Centers.
PECOS (Provider Enrollment, Chain, and Ownership System) requires providers to revalidate their enrollment periodically. Missing the revalidation deadline can result in deactivation of your Medicare billing privileges. GuardWell tracks these dates and sends advance reminders.
GuardWell provides structured audit checklists for coding accuracy, modifier usage, E/M documentation, and claims review processes. You can document your internal billing audit program systematically and generate reports showing your audit activities for compliance reviews.
Under the Affordable Care Act, providers must report and refund Medicare overpayments within 60 days of identification or face False Claims Act liability. GuardWell's billing compliance module helps you track identified overpayments and document timely refund actions.
Yes. The CMS module includes an emergency preparedness checklist covering the four core elements: an emergency plan, policies and procedures, a communication plan, and training and testing documentation. GuardWell tracks drill schedules and sends reminders for annual updates.
GuardWell provides structured checklists for internal billing audits covering coding accuracy, claim scrubbing, modifier usage, and documentation standards. You log audit findings, track corrective actions, and generate compliance reports that demonstrate your ongoing audit program to Medicare contractors.
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GuardWell covers 15 compliance areas in one platform.