BC Advantage - 2014 Issue 8

Deliver Results Effectively - How to educate providers

By: Sean M. Weiss, V.P. and Chief Compliance Officer"Doctor, your documentation does not support the level of service you billed to the insurance company..." These are the dreaded words every auditor delivers and the words every provider despises hearing. But, what if we as an auditor are wrong; what if the level is supported based on complexity, but as non-clinicians, we were not able to make the correct assessment? Auditing should be looked at two (2) ways: as a qualification and quantification process. According to Merriam-Webster, qualification is "a special skill or type of experience or knowledge...

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