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Payer Audits

Payer Audits

Medical insurance audit

4 Lessons You Can Learn From Medical Insurance Audits

It can be challenging to see a medical insurance audit as anything other than a headache. After all, auditors require reams of documentation, and there’s always a chance they’ll uncover a missing CPT code, an undated progress note, or another issue that requires you to pay back what you received from payers. However, you may […]
Published Date: July 16, 2024
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Insurance audit

8 Tips Help Build Your Practice’s Insurance Audit Response Plan

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 […]
Published Date: June 9, 2024
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Recovery audit contractors

Prepare for Your RAC Audit With 7 Time-Tested Tips

When a recovery audit contractor (RAC) decides to audit your practice, you must cooperate, or you can be excluded from Medicare or cut off from reimbursement. It’s also important not to panic. As long as you have a RAC preparation strategy, your audit should go smoothly. Get ready for recovery audit contractors with these seven […]
Published Date: April 10, 2023
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Medicaid audit

OIG Outlines the Biggest Medicaid Audit Findings of 2022

If you were curious about whether the OIG had stepped up Medicaid audits as the pandemic’s effects began to wane, it’s time to stop wondering. The agency finalized 1,327 convictions last year, recovering $1.1 billion during 2022. And even though many practices equate audits solely with Medicare, the latest OIG report confirms the fact that […]
Published Date: March 28, 2023
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recovery audit contractors

Avoid Paybacks to RAC Auditors by Following 7 Essential Tips

One audit type that’s always looming over medical practices involves Recovery Audit Contractors (RACs). These organizations are appointed by each MAC to uncover, confirm, and take back reimbursements Medicare made in error. Because they get paid a percentage of what they recover from medical practices, RACs are sometimes referred to as Medicare’s “bounty hunters.” Recovery […]
Published Date: November 21, 2022
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RAC Audit

RAC Audit Response and Appeal Survival Tactics

Although last year’s pandemic put a brief pause on Recovery Audit Contractor (RAC) audits — this year they are once again in full swing. Auditors are picking up the pace to make up for lost time. So, your chances of getting audited are higher than ever before. What is a RAC Audit? RAC audits are […]
Published Date: April 13, 2021
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OIG Telehealth Audit

Learn How to Avoid Telehealth Audit Traps

It’s now official: your telehealth services are on CMS’ radar. The Office of Inspector General (OIG) just announced that it will start reviewing claims for specific violations. The last thing you want to do is pay back money for incorrect telehealth reporting. But that’s exactly what could happen if you don’t tighten up your telehealth […]
Published Date: July 16, 2020
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third-party payer appeals

6 Tips for Successful Third-Party Payer Appeals

When even the slightest mistake on a claim form can lead to a denial or reduced reimbursement, you need to be on your toes. The good news is with some leg work third-party payer appeals can get you paid more of what you are due. While third-party payer appeals are a time-consuming complex process, they’re […]
Published Date: November 1, 2019
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OIG Watch List: Protect Payments from Urine Drug Test Audits

The Office of Inspector General (OIG) added to its Workplan items that contractors will audit or evaluate with a more critical eye. If you bill for urine drug test or speech-language pathology services to Medicare beneficiaries, now’s the time to weigh your compliance risk and fix any issues. OIG Scrutinizes Urine Drug Test, Speech-Language Pathology […]
Published Date: October 31, 2019
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