Netzealous - Common Audit Triggers

The elements of a payer audit
A payer audit is, in bare terms, a review of the accuracy of a medical bill by an independent reviewer, such as an auditor or a coder. No matter which kind of payer a medical bill originates from–Medicare, Medicaid, or private payers –it can be subject to a payer audit.

This payer audit is carried out for the same reason for which most other audits are: To ensure that the right supporting documents accompany the medical bill on which a claim is made by a recipient, such as an individual, an employer, employee or service provider such as a hospital or a physician. For the purposes of a payer audit, the payer is allowed to request documents that are used for supporting reimbursement claimsfrom the recipient, such as invoices or medical records or similar ones that have been generated over the past year, or more, if necessary.

Payer audits are on the rise
Since payer audits are a very strong means for checking inaccuracies of payments made to recipients; their incidence is now on the rise. Since the healthcare payments industry is convinced about the efficacy of payer audits; they are carried out regularly and for all sources of payment, even if they are considered tedious and cumbersome. Payer audits are an effective safeguard for both the payer and the recipient for the following reasons:

• Payer audits ensure that the payer is receiving the right supporting documents for every transaction 
• Payer audits also make sure that the recipient is claiming the right amounts with the proper supporting documents, absence of which can lead to a situation in which she wakes up one fine day to hear from the payer that huge amounts were overpaid to her and that they need to be remitted at short notice.

Payer audits have to be smart and efficient
Since the payer audit is the mechanism to ensure that there is all-round accuracy and authenticity of supporting documents at all stages of the claims; it is natural that it is sophisticated and effective. It is important for payer audit systems to have the inbuilt features to help them recognize a faulty claim and ask for the right billing patterns and methods.

Want to understand the ways by which payer audits can perform their tasks without complication or difficulty? Want to make sure that your organization does not overpay because of the lack of an effective audit? If you are in individual recipient, do you want to understand how not to receive a notice for overpayments and avoid being penalized?

A webinar is what you need to get a thorough understanding of all these elements of a payer audit. Enroll for this insightful learning session at http://www.mentorhealth.com/control/w_product/~product_id=800707LIVE/~sel=LIVE/~Dorothy_D.%20Steed/~Common_Audit_Triggers_and_a_Look_at_Multiple_Cases from a renowned healthcare consultant, Dorothy D. Steed.

Dorothy, who has nearly four decades’ experience, will spell out the practical aspects of a payer audit.
She was a Medicare specialist for a large hospital system and a physician coding audit supervisor for another hospital system. Additionally, she is an instructor at a state technical college in Atlanta, provides auditing and training in both facility and physician services, and has been a speaker at several healthcare conferences.

Getting to what triggers a payer audit
 

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