How to Prepare for an Audit

Audits have been ramping up, by the federal government and by payors. Given the many changes in billing and waivers due to COVID-19, payors are catching up to make sure practices are billing accurately. 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, it’s not surprising that the government is now increasing its reviews.

Many of the upcoming audits will relate to COVID-19, but also payors that stopped or slowed audits during the height of the pandemic are now getting up to speed. 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.

We have already 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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