Total Health Law Blog
Our healthcare and business law firm often assists medical practices in responding to medical record and coding audits initiated by private and governmental payors. Responding to each payor is unique. The way I might respond to a private payor may differ from how I respond to a government payor. This post, however, provides a few tried-and-true tips to consider when faced with an audit. If you have questions about an insurance audit or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@hamillittle.com. You may also learn more about our law firm by visiting www.hamillittle.com.
Tip 1- Hire Counsel
Although this sounds self-serving, it is not. Attorneys who are experienced assisting medical practices with responding to insurance audits are well worth their cost. I’ve learned this from clients who tried to respond to audits without the assistance of counsel who then come to me for help in a situation much worse off than if they had started with counsel from the beginning of the audit. Counsel can help you understand what the payor is concerned with (sometimes it’s an isolated issue yet other times the payor insinuates concern with fraud), connect you with medical record and/or coding experts as needed, prepare responses that are fully responsive and advocate for your situation, and establish a good relationship with the payor, which can be immensely helpful in working through an audit.
Tip 2- Get a Compliance Expert Involved
Getting a compliance expert involved can be a game changer for two reasons. First, it shows to the payor that you are serious about understanding whether there is a deficiency and fixing it. Second, it will allow you to know how to correct a deficiency if there is one. If there is not a deficiency, a compliance expert will help you and your attorney prepare support showing why there isn’t one. Compliance experts understanding coding and documentation requirements based on each insurer’s specific requirements.
Tip 3- Respond Promptly and Fully
At the top of your attorney’s list should be responding to the audit notice, letting the payor know you are represented by counsel, and explaining to the payor that you are taking the audit seriously. One way to show how seriously you’ve taken it is that you have hired counsel and a compliance expert. If there is a deadline within the audit, meet the deadline. If there are “bad facts” to disclose, get ahead of them with your counsel and do not try to conceal them. If the payor views you are not taking it seriously or attempting to conceal facts, that will only place you in a worse position.
If you have questions about an insurance audit or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@hamillittle.com. You may also learn more about our law firm by visiting www.hamillittle.com.
*Disclaimer: Thoughts shared here do not constitute legal advice.