Audits have been ramping up, by the federal government and by payors. Audits have been increasing ever since the COVID-19 pandemic. If you haven’t already been notified of an audit, you may expect one soon.
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Given the flexibility that was put into place during the COVID-19 pandemic and the increased cyber breaches and skyrocketing cybercrime, it’s not surprising that the government and payors are now increasing reviews.
Providers should be prepared for the uptick in audits and potential inquiries.
Providers using telehealth or providers who utilized telehealth during the pandemic should be especially vigilant.
The Centers for Medicare & Medicaid Services (CMS) has indicated they are closely monitoring the use of the modifier for telehealth. Also, with the increase in cybercrime, it is important to show that you have adequate protections in place. HIPAA sanctions are occurring for those not following HIPAA regulations.
We have seen a shift to post-payment audits and increased scrutiny for managed care payers.
How can you protect your practice in light of the increased audits?
First, perform your own audit. Utilize legal counsel to help with your audit to make sure that your records are in order and your findings are protected by attorney-client privilege.
Follow up with adequate training of all staff and physicians. Make sure to thoroughly document the training and any other actions that were taken to address any issues.
Ensure that all of your documentation is up to date and your risk assessment is continuously updated.
If you have any questions about waivers, ask your healthcare attorney today.
Let us know if your practice has already been audited by commenting below.
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