Payor Audits Uncovered: Types, Demands & Effective Appeals

Government payors and commercial insurance companies rely on pre- and post-payment medical record and billing audits to determine if provider services were medically necessary, accurately billed, and appropriately paid. Over the past few years, Medicare significantly increased the types and numbers of audits and outsourced many the record reviews to private companies. With so many of these private companies conducting audits on behalf of the Medicare program, it is not a matter of if a provider will be audited, it is a matter of when.  Moreover, many of the contracts with private auditing entities incentivize denials by tying compensation to the amount of money recovered.   Negative audit results can lead to significant penalties, including repayment, financial penalties, de participation, and even prison in the worst cases. 

Commercial insurance companies also rely on medical record and billing reviews of participating providers to ensure that the services meet all utilization, medical necessity, and payor policies.

There are steps providers can take to minimize the chances of a negative audit result.  Join our expert speaker Vicki Myckowiak for an intensely practical discussion on the best way to handle payor audits from the receipt of the record request through submission of the records and learn about best practices for handling appeals of adverse findings.

Webinar Objectives

Medicare, Medicaid, and commercial insurance companies rely on medical record and billing audits to ensure proper utilization and medical necessity of billed services as well as the accuracy of payment for services provided.  This webinar will walk providers through best practices for responding to audits and appealing negative findings, if needed.

Webinar Agenda

• What are the types of payor audits?
• What is the best practice for complying with audit demands?
• What are best practices for appealing denied claims?

Webinar Highlights

• The types of payor audits
• How providers are selected for payor audit
• Best practice for providing requested records to payors
• The merits and pitfalls of providing more than the requested records
• Tips for successful appeals of audit denials

Who Should Attend

Physicians, practice administrators, billing companies