A lot of healthcare providers will deal with audits eventually, which are needed to uncover any potential violations and errors that could cause severe repercussions for medical facilities. If you’re going to get through a payer audit, there are certain mistakes you will want to avoid doing. Here are some of the payer audit mistakes to avoid in your medical facility.
Once you get a payer audit request, you only have a certain amount of time to submit all of the appropriate documents. Payer audits may be requested either by the Center for Medicare and Medicaid Services and/or by any private healthcare insurance provider, and you’ll want to respond to them promptly.
If you miss a deadline, you could face heavy penalties and fees. If an extension is needed, you should request one the moment you know you’ll need one. Lastly, if a payer does not give you a deadline right away, you’ll want to get that deadline from them so you’ll know when all of your data is needed.
Another mistake that may be made during a payer audit is having the wrong documents to send out. Healthcare practitioners need to prove that whatever medical procedures they are providing are vital for treating their patients, and this is easier said than done because there can be disagreements regarding what’s deemed as “necessary”.
To combat this issue, take some time to inform your staff on what payers would consider as “medically necessary”. Another option you have is to document needs for specific procedures as clearly as possible. However, the best thing you can do is get authorization from your payer before you render any services.
Not Using the Correct Codes
If you don’t use the right codes and billing practices, you might be suspected of failed claims, fraud, or yes – payer audits. Coding systems are supposed to streamline billing processes, and these systems include all medical procedures you could think of, whether it’s a visit to the doctor or a ride in an ambulance.
A large number of medical bills have errors within the United States, but you can lower this number if you put the time and money into getting yearly updates for your medical coding procedures handbooks, and by avoiding the use of any outdated medical codes.
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