Receiving a request for medical records for prepayment or post-payment audit can represent the costs of providing the requested documentation or the cost of providing the requested documentation plus amounts paid (or pending payment) for the services rendered. Payers (government and private) request records to determine if a claim for payment is supported by medical record documentation. How your practice responds to the requests from an external auditor may have as much effect as how well services were documented and codes selected. Here are some tips for creating a process that can help your practice avoid unnecessary loss of payments based on some common audit findings in a sampling of published audit results.

Insufficient documentation is often the cause of denied claims and overpayment requests. Avoid common errors in documentation, such as

It is important to know the volume and outcomes of payer audits. By tracking the volume of each...

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