Medicare Payment Audit & Workflow Modernisation
Large Healthcare & Rehabilitation Network — USA
The Challenge
A high-volume Medicare payment operation was running on unsupported legacy infrastructure with no reliable safeguards before submission:
- Error-Prone Submissions — No field-level edit checks or validation meant payment errors routinely passed through undetected until after submission, triggering expensive manual correction cycles
- Compliance Exposure — Absence of audit trails and reconciliation controls created significant risk during internal reviews and external Medicare audits
- Operational Drain — Finance and billing teams spent disproportionate time firefighting post-submission rework rather than managing payment strategy or compliance proactively
The Solution
KT2i designed and delivered a modern, automated payment workflow using Microsoft Power Automate and .NET, replacing the legacy platform entirely. Business rules and Medicare validation logic were implemented in .NET services tightly integrated with the workflow engine, ensuring every record passed structured field-level checks, mandatory data validation, and rule enforcement before it reached submission. Role-based access and full end-to-end activity logging were built in by design, not retrofitted.
- Automated Audit Workflow — Centralised Power Automate workflow routing every Medicare payment record through defined validation, audit, and approval steps with enforced segregation of duties
- .NET Validation Engine — Medicare business rules and field-level edit checks implemented in .NET services, catching errors at data entry rather than post-submission
- Pre-Submission Reconciliation — Finance and audit teams given real-time reporting to review, identify discrepancies, and resolve issues before any record reaches Medicare
- Full Audit Traceability — Every action from data entry to approval logged with timestamps and user attribution, creating a clean compliance trail for internal and external audit
The Final Results
- Error Reduction: Field-level validation and pre-submission reconciliation dramatically reduced Medicare payment error rates, with discrepancies resolved upstream before they could trigger resubmissions
- Audit Readiness: End-to-end traceability across every record gave compliance and finance teams the confidence to face internal reviews and external Medicare audits without preparation overhead
- Operational Efficiency: Eliminated the manual rework burden that had consumed significant finance team capacity, redirecting effort toward higher-value reconciliation and oversight activity
- Payment Velocity: Faster, cleaner submission cycles reduced payment delays, improving cash flow predictability across the Medicare reimbursement operation
- Platform Longevity: Unsupported legacy infrastructure fully replaced with a scalable, maintainable architecture aligned to the organisation’s long-term compliance and growth needs

