Appealing a Negative Audit
Insurance Audit Facts:
Medicare, Blue Cross, VSP and other payers are performing more audits than ever before
Auditors are much more aggressive
More practices fail an audit than pass
Penalties for negative findings are between $125,000 to $200,000!
Many doctors believe using an EHR system keeps them compliant
Frequently this is not true. Many EHR systems produce non-compliant records
You need to make sure you will pass an audit.
· These audits are being conducted for a number of reasons including exam documentation and creation of Interpretation and Reports. We ensure your exam documentation will meet or exceed NCCI standards. We also will verify you are creating compliant Interpretation and Reports.
· Many Medical Records systems falsely verify exams as complete. Missing key exam requirements. Auditors specifically look for these. We know what the auditors are looking for. We will detail your exam deficiencies before the auditors do.
· Practices hit with a negative audit are frequently surprised and frustrated. They previously passed an audit and have the same records. However, in many cases these practices only had a "Request for Records." This is not a full audit. Even if you had a previous audit, all payers are now much more aggressive in audits than even a couple of years ago. The auditors are looking to find problems!
· In the audits we perform in almost every case, the practice would have failed an insurance audit for high penalties. In every case we were able to identify specifically where their records were not compliant, make detailed recommendations enabling the practice to be fully compliant! We can do the same for you! Let us help you before you are audited!
· Pulling forward information from previous exams without making changes is considered "Cloning" by CMS and other payers. This will result in denials.
· Another advantage of our audits is that we look at lost reimbursement. Procedures you should be performing, lost reimbursement and incorrect or non-existent EOB processing. In most cases the lost reimbursement we find is more than the cost of the audit.
We know what the Auditors are Looking for?
Protect Your Pocketbook!