CMS Medicare Compliance Software for Medical Practices

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.