tci Medicare Compliance & Reimbursement - 2006 Issue 17

AUDITS: Get To The Bottom Of Audits--And Come Out On Top

3 red flags could make providers' claims suspicious.Why do bad audits happen to good physicians?Physicians aren't wasting their time when they ask why their carriers have decided to put their evaluation and management claims on prepayment audits. In fact, this may help providers get off prepayment review more quickly, say experts.Providers should ask themselves, "Why was the physician put under a prepayment audit in the first place? What was the red flag? Was she billing too many high-level codes? Too many consults?" advises Suzan Hvizdash, medical auditor with University of Pittsburgh Physicians department of surgery...

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