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Both government and private payers continue to aggressively monitor providers to prevent and recover overpayments. This is evidenced by the fact that the number of audits conducted in recent years has increased dramatically. A negative audit finding can result in the need to repay five- or seven-figure amounts. Types of Audits Private Payer Audits Private…
Prior Authorization Is Under Review
I just couldn’t believe it. Like all of you, I receive many requests to see patients urgently. And like all of you, I can’t possibly accommodate all of those requests. So I triage: I look through the referrals and try to differentiate patients who want to be seen from those who need to be seen….
Different Payer Audits Require Different Preparation & Response
For a provider of healthcare services, payer audits are always a possibility. Both government and private payers consistently monitor providers to prevent fraud, overpayment, and improper billing or coding procedures. Audits can be nerve-racking and intimidating, even if a provider is billing correctly. Improper billing can lead to civil and criminal sanctions. To alleviate some…