Editor’s Note: Cutting through the red tape to make certain that you get paid for every dollar you earn has become more difficult than ever, particularly in our current climate of health care reform and ICD-10 transition. The ACEP Coding and Nomenclature Committee has partnered with ACEP Now to provide you with practical, impactful tips to help you navigate through this coding and reimbursement maze.
Question: I’ve received a payer audit. What does it mean, and what should I do?
Answer: The first thing to know is that you are not alone and there are resources to assist you. The next thing to know: Do not ignore the audit. It will not just go away.
How you respond to a payer audit may vary, but you should respond. Audits are used by payers for many reasons, such as validating coding and recouping overpayments. You can usually contest the findings of an audit, but you should be aware of the rules and regulations governing how to respond to the payer and the timeline for each step in the process because they vary for each payer.
The ACEP Reimbursement Committee has published very complete resources addressing what audits are and how to deal them..
ACEP, in association with the Physicians Advocacy Institute, has also published a toolkit specifically about dealing with audits.
Brought to you by the ACEP Coding and Nomenclature Committee.
Dr. Lempert is chief medical officer, coding policy, at TeamHealth, based in Knoxville, Tennessee.