Our healthcare and business law firm often assists medical practices in responding to medical record and coding audits initiated by private and governmental payors. If a payor believes there are consistent concerns with a medical practice’s claims, the payor may place the practice under a prepayment review process. This process can be very concerning to a practice and, in some cases, can place a practice at risk of shutting down. A previous post provided an overview of standard claims processes versus a prepayment review process. Prepayment review processes are different depending on which payor you are dealing with and whether the payor is private or government. Herein, I provide a few tips for dealing specifically with TRICARE/Humana Military regarding a prepayment review process. If you have questions about an insurance audit or prepayment review process 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, firstname.lastname@example.org. You may also learn more about our law firm by visiting www.hamillittle.com.
In a previous blog post, I presented three tips for dealing with an audit from any payor. Those tips remain relevant for trying to end a prepayment review with TRICARE/Humana Military. The below tips are targeted specifically for dealing with a prepayment review process with TRICARE/Humana Military that is causing harm to your business due to the lack of claims being timely paid.
Tip 1: Get Your Community Liaison Involved
As a TRICARE provider, you have a Community Liaison that you can connect with via email and through the portal. Your Community Liaison is there to answer your questions and connect you with the right people. Continue reading ›