If you have Failed an Insurance Audit
We Can Help!
   

       

 

 

How Nteon Practice Consultants Will Help Your Practice Appeal the Findings

Insurance audits have become much more prevalent.  We have seen many audits performed by Insurance companies, including Medicare, Medicaid, Blue Cross, VSP as well as other payers. 

Most penalties are between $150,000 and $225,000 though many penalties have exceeded $1,000,000!

We have successfully appealed many negative insurance audits, throughout the country and for all payers. 

Some practices were also removed from the insurance companiesí panels.  We have successfully defended doctors and had them reinstated.

For the most part these audits were against practices who were following what they thought were good coding, billing and documentation processes.  Unfortunately what the Insurance Auditors are looking for is not a good medical examination.  They are only looking for technical components.

There are many factors that cause practices to fail an insurance audit.  These are described it the section, "Your Chances of Being Audited".

Our first step in defending a doctor or practice from a negative audit, is to thoroughly review the insurance auditor's report.  We typically find mistakes by the auditor that resulted in much higher penalties.  We have appealed the findings and in most cases significantly reduced the penalty.

In many cases, the doctors have first turned to their lawyers.  However, the lawyers are not aware of which procedures are supported by which diagnoses and miss significant auditor mistakes.  In several cases practices were recommended to settle and when we reviewed the auditors findings we challenged new areas and significantly reduced the proposed settlement amount.

The most successful approach is to first review the auditor's findings.  We then prepare a detailed report identifying incorrect findings and conclusions by the auditor.  We also recommend how much the penalty should be reduced or even eliminated.

At this point we work with the practice's attorney (or recommend one) to file the appeal.  We work throughout the appeal process and hearings to negotiate a beneficial result for the practice.

  

 

Call Toll Free:  888-866-5367
or
Email us:  info@NteonConsultants.com