In New York, a commercial health insurance audit examines a medical provider’s compliance in terms of processing claim payments. If an auditor finds discrepancies, it can lead to negative consequences that can affect your organization’s finances, operations and reputation.
Receiving a notice from an insurer can be daunting, but understanding the steps afterward can help reduce anxiety. Consider these three tips to assist your audit preparation.
Review the notice thoroughly
Begin by reviewing the audit notice thoroughly. Doing so will help you understand the insurer’s scope of the audit, which may include a specific period, issues, and claims.
While most notices include a scope, you may receive a document that does not specify the type of audit. In this case, assign a single point of contact to communicate with the auditing entity and verify details.
Gather documents related to the audit
Once you have the complete details about the audit, proceed with preparing the relevant documents. This may include billing records, patient information and communication with the insurer.
Organize all papers in an accessible manner, allowing the auditor to easily retrieve what they need. Review the document’s accuracy and completeness before submitting on time to avoid losing future payments or facing a fraud charge.
Conduct an initial assessment
Consider conducting an initial assessment on the codes and billing patterns that an auditor will examine. This step can help you detect potentially inaccurate invoices and inconsistencies with an insurer’s policy manuals, giving you time to take corrective action.
Manage a medical insurance audit with assistance
Navigating a medical insurance audit can be overwhelming since the process requires meticulous attention to detail. While these tips can help you manage the process, there may be some aspects that fall outside your internal expertise.
If you are unsure how to proceed with the audit process, a health care attorney can offer clarity and guidance. They can walk you through the legal implications of an audit and help you draft a formal and timely response.
