Best Practices for Managing Commercial Audits
With claim audits from payers on the rise, it is essential that providers properly manage the process of commercial payer audits and understand what’s expected. It is also important that physician groups and other healthcare providers prepare for and anticipate potential issues to minimize pricey takebacks and offsets when such an audit does arise.
Reviewing and implementing audit best practices before, during, and after an audit can help ease the oftentimes stressful process and ensure more favorable audit outcomes.
- Collections and payments: Processes for keeping records of invoices sent, attempts to collect and payments made, as well as collecting patient cost-sharing obligation should be established and implemented.
- Records Hygiene: The EMR system should be kept up to date, with frequent internal checks ensuring the records reflect what the care provider intended to put on file.
- Checks and Balances: Internal audits will ensure the practice is in line with the payers’ rules and stipulations regarding billing and record keeping.
- Policy Preparedness: A practice should have set policies on how they will respond to any audit requests, and training billers and receptionists accordingly. Don’t wait until the audit letter arrives.
- Seek Counsel: If an audit occurs, it is essential to be proactive, complying with document requests, submitting complete records, adhering to deadlines, and double-checking all automated processes, particularly E/M code calculators. Seek advice from your attorney on properly and lawfully responding to the audit.
For guidance on navigating payer audits, contact us.
Related practices: Healthcare, Managed Care, Litigation
