Many of our healthcare and business law firm’s clients periodically face audits by insurance companies or governmental organizations, usually through a contractor. Audits can be unnerving times for a practice to go through. This blog post outlines 3 tips for handling an insurance audit. The Centers for Medicaid and Medicare recently published that the flexibilities allowed during COVID-19 will soon end and practices should ensure compliant safety and billing practices. As a result of this change after two and half years, practices may see increased audits. If you have questions regarding this blog post or need counsel navigating an audit, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, firstname.lastname@example.org. You may also learn more about our law firm by visiting www.hamillittle.com.
- Take it Seriously at the Initial Record Request (and Not Just When They Ask for Repayment).
Many practices call us after the auditor requests repayment. Almost always, the process starts before then with the auditor initiating an investigation by requesting additional records and information. After the repayment is requested, however, there is an uphill battle to argue on behalf of your practice that no or less repayment is warranted. The best chance that your practice has of both reducing any requested overpayment and persuading the auditor not to expand its investigation to more patients or a larger time period is during the response to the initial request for records and documentation.
- Hire Counsel and a Compliance Consultant
Every client’s financial situation is distinct, but if you are able, the best chance of minimizing adverse outcomes is by hiring counsel and a compliance consultant. Counsel can assist you in putting your best foot forward with your written response and what documents you send. A compliance consultant is useful in that they essentially audit your company to try and determine what the auditor may find as noncompliant or even fraudulent and can educate you in modifying your practices. If you hire counsel and your compliance consultant separately, ask them to collaborate. One way to attempt to prevent the audit from expanding in time/patients is to show the auditor that you have adopted improved practices and protocols with the help of a compliance consultant.
- Think Outside the Box
If you think you are deficient in an area, like billing practices, documentation, etc., work with your counsel to think outside the box. In order for your counsel to think outside the box, be sure to tell your counsel everything about your practice, not just what you think may be deficient. There may be one best way to do something—and your compliance consultant can help you achieve that going forward—but there may be creative ways to show the auditor that you are compliant (or at least not fraudulent) even if you know you have not maintained good practices.
There are, of course, numerous considerations in responding to an audit. The above tips are intended as a few general pieces of guidance if you or your practice are audited. If you have questions regarding this blog post or need assistance responding to an audit request, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, email@example.com. You may also learn more about our law firm by visiting www.hamillittle.com.
*Disclaimer: Thoughts shared here do not constitute legal advice.