When the Auditor Beckons – Ophthalmology Management

That letter has come, and it doesn’t send birthday wishes. Are your records in order? Great. If not, consider it a teaching moment.

Non compliant and audit — two words no physician or practice administrator wants to hear. To help ensure that they don’t, practices must make sure their reimbursement claims are accurate and that they adhere to billing regulations, all part of their quality assurance and compliance efforts.

Medicare and other payers review claims and payments through postpayment audits. The objectives of the Fraud Prevention Initiative, which the Centers for Medicare & Medicaid introduced in 2011, included avoiding payment for erroneous claims and removing providers and companies that submit fraudulent claims from participating in federally funded healthcare programs. This leaves providers questioning how to respond if (or when) they receive notification of a postpayment audit.

In this article, I provide steps to consider when navigating the audit process.

• Determine who is involved
• Assemble a response team
• Watch Deadlines
• Prepare the documents
• Catch’em while you can
• The results are in

This article was published in Ophthalmology Management, May 2016, and written by Corcoran’s Senior Consultant, Mary Pat Johnson, COMT, CPC, COE, CPMA.

http://www.ophthalmologymanagement.com/articleviewer.aspx?articleID=114227