Wiki Audits

[lring]

I hope some of you can help me. I've been told by my new management that it is not 'that unusual now' to do post-payment audits. Am I correct in that anything I identify would have to be paid back (or whatever the case may be to correct)?

I have always done pre-pay audit reviews to provide education and correct any errors before billing.

Anyone else doing post pay reviews?

All help is appreciated.

thanks

 

[jbaltimore]

Hi Lynn!

You are correct in stating that anything you find -e.g. overpayments, underpayments, incorrect payements from the payer must refunded. This goes for patient payments as well when a true patient credit is discovered.

This is the appropriate corrective measure for "return of funds to carrier". Failure to disclose overpayments within 90 days of discovery can result in the government alleging a knowing and willful attempt at concealing the overpayment. This is considered a criminal violation.

Jennifer Baltimore

 

[FTessaBartels]

Post-payment audit

We perform post-payment audits and always promptly send corrections (including refunds as appropriate) when we discover discrepancies/errors.

F Tessa Bartels, CPC, CEMC

 

[LLovett]

We do both.

New providers are audited 100% before billing until they meet the compliance standards. Then they are put on an audit rotation. If I find errors after they are paid we either rebill or refund. If they slip below a certain percentage they are put back on 100% audit and I spend more one on one time with them working on their problem areas.

Laura, CPC

 

[lring]

audits

thank you all - I have always done pre-payment audits to avoid paybacks - but it looks like I may be doing post pay and refunds now - this is a great forum - everyone of us needs help at some point!