An insurance audit isn’t something you should ever take lightly. Therefore, it’s vital to respond appropriately if you do get news that an audit is hitting your practice.
Consider these eight tips so you can respond compliantly if your practice gets an insurance audit letter.
1. Read the Insurance Audit Letter Carefully
Some practices skim over the audit letter and then set it aside to address later, but this isn’t an ideal habit. Instead, you should read it carefully so you can thoroughly grasp exactly what the auditors are seeking. This will allow you to provide all of the requested information when responding.
2. Contact Your Attorney
Even if you don’t expect any pushback from your insurer when they receive your documentation, you should always talk to your attorney. Your legal team can advise you on the audit’s level of seriousness and how best to respond to it. Don’t assume that the audit is simple and routine — treat all requests for information seriously.
3. Ensure All Medical Records and Copies Are Legible
When you’re gathering your medical records to submit for the audit, read through them to ensure that they’re easy to read. If the records aren’t clearly readable, have the illegible record transcribed and included with the copies of the original records. Make sure no information has been cut off.
4. Include Related X-Rays or Other Diagnostic Studies
If the patient records in question refer to imaging studies, blood tests or any other diagnostic testing, you should include those in your records along with the encounter notes or operative reports. These are part of the patient’s overall record, so they shouldn’t be ignored.
5. Don’t Alter the Medical Records After Receiving the Audit Notice
Never change the records before sending them to the payers. However, if there are orders, consults or other materials that haven’t yet been filed, file them as you normally would.
6. Include a Brief Summary of the Patient’s Care With Each Record
You should include a summarization of the encounter with each record you’re sending to the auditor. This doesn’t replace the record itself, but helps any auditors who aren’t familiar with your specialty as they dive into your files.
7. Insert Supporting Guidelines
If you want to share justification of why you used a specific code on your claim, you can submit supporting documentation with the records. For instance, local coverage determinations or medical literature can help you support what you reported and why.
8. Send Documentation by Certified Mail
Always submit the materials to the auditor before the deadline, and send all communications by certified or express mail. Request return receipt from the shipping carrier so you can confirm that the auditor received your documentation and you’ll know when they got the records.
Remember to retain complete, legible copies of all correspondence and documents you submit, with each copy of the medical record labeled accurately.
You can navigate an audit with ease if you know how. Healthcare attorney Osato F. Chitou, Esq., MPH can show you how during her online training event, Medicare Audit Survival Tactics to Help Your Physician Practice. Sign up today!
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