tci ED Coding & Reimbursement Alert - 2015 Issue 3

Unfavorable Audit? Don't Think Twice About Appealing

If you’ve taken a hit from RAC auditors, think twice before just writing a check for alleged overpayments. ED groups are an attractive target for auditors because the size of the groups tends to be much larger on average than other specialties. This means when audits identify overpayments, the potential for recoupment is larger because of the volume of claims reported by the group. The cost of extrapolation with these volumes can get expensive very quickly so you should appeal any audits that seem unfair or inaccurate. Check out this scenario from Ed Gaines, JD, CCP, Chief Compliance...

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