Medical billing audits are necessary and if approached correctly, can be beneficial for your practice. Keep reading to learn more. 

Medical Billing Audits…Not Something to Fear

A medical billing audit may feel like your practice is under scrutiny by a third party trying to find an error or errors you’ve made and punish your practice for them. However, medical billing audits are necessary to improve efficiency, avoid claim denials, and ensure compliance. They can actually be a very positive thing for your practice, especially if you safeguard your practice to be ready for them. 

Medical practices may face external audits from both governmental entities and private health insurance providers. These institutions pay claims and want to make sure that what they are paying out is correct. If your practice is facing an audit, it is important that you focus on getting the auditor what they need to complete the audit and not focus on possible repercussions of the audit. Making a mistake during the process of providing information could lead to more issues down the road. 

An audit can be randomly scheduled or can target a specific practice for a specific reason. Most of the time, an audit is issued because an insurance provider, or the government, believes they have overpaid for something and want to recover those funds. However, if your practice has started offering a new treatment, bills for things that similar practices don’t, or generates significant revenue, your practice may trigger an audit. 

If you’ve received a notice that your practice will be audited, make sure to read it carefully and completely. Information including the type of audit, the timeframe of the audit, and the information you need to provide will be mentioned in the notice. Keep in mind that medical billing audits can be helpful to your practice, but it is important to take them seriously and contact your attorney before responding. 

Step 1: Responding to an Audit

Auditors will request information or documentation within their formal notice of an audit. Your practice should follow the Health Insurance Probability and Accountability Act (HIPAA) by cooperating with the audit and only providing the requested information. By responding promptly to the audit, you place your practice in the best light by appearing transparent and showing your commitment to providing quality care. 

You shouldn’t discuss the audit with anyone else at your practice until you know exactly who is requesting the audit, what information they are seeking, and have reviewed the appeal process for the entity auditing your practice. You should also consult with a criminal defense attorney before responding as there could be legal issues to consider based on the details of the audit. 

Step 2: During the Audit 

Make sure that any questions posed by the auditor are written down and provided to you. Do not have open communication with the auditor as this could lead to information being passed on that does not necessarily need to be passed on. Having all questions submitted in writing gives you a chance to review them and evaluate them with your attorney. Your attorney can advise you on what you need to provide to the auditor based on what was lawfully requested. 

Step 3: After the Audit 

Once the audit is over, the auditor should provide you with the findings of the audit. Minor issues like documentation mistakes can usually be resolved, but if there are larger problems like over-billing or billing for the wrong services, there may be liability issues for your practice. 

Keeping track of every paper received from the auditor, as well as copies of everything you turned over to the auditor is important. Conferring with your attorney during, and after the audit is essential to understanding exactly what was found, and if there will be further investigation into your practice’s business. 

The Importance of Legal Representation During an Audit 

Retaining the assistance of a healthcare attorney even before receiving an audit notice is a smart idea. An experienced attorney can help provide legal advice, is familiar with the complex structure of an audit, and can communicate with the auditors on behalf of your practice. They can also help prep the documents your practice needs to provide the auditors and point out any concerns along the way. 

The team at the Law Offices of Robert J. DeGroot can provide these services to your medical practice. With decades of experience, you can rest assured that the audit your medical practice is facing will be conducted fairly and legally. 

Is your medical practice facing a medical billing audit? Reach out to the Law Offices of Robert J. DeGroot today!