Payer Audits: Defending Yourself Against the Inevitable

Presented by: Dr. John Stimler, DO, CPC, CHC, FACEP
Total Run Time: 1:01:19
AAPC Approved for 1.5 CEUs or CEDC, CPCO, CPMA Specialty Credits

Due to increasing pressure to improve accountability and reduce costs for federally funded medical care, the incidence of governmental audits by both Medicare and state Medicaid programs is on the rise. Careful evaluation of governmental audits is critical to identifying common patterns of audit processes, high risk chart documentation areas, exposed codes, and reimbursement practices that have been questioned by MACs.

Topics include:
• Factors that generate payer audits.
• Types of cases that auditors typically flag for review.
• The most common reasons that auditors give for downcoding cases, and recommendations for responding to each.
• Medical necessity and auditor assumptions.
• Preparing for the inevitable. What to do before you receive an audit notice.
• Managing the Medicare Appeals Process Administrative Law Judge hearing update.

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