How to Respond to a Payor Audit: Medicare and Beyond-Webinar Recording

Video Transcription

Video Summary

The webinar "How to Respond to Payer Audits" presented by health care attorney Ms. Koviak covers essential strategies for medical practices facing audits by Medicare and commercial payers. She emphasizes that audits are inevitable due to increasing scrutiny on billing and coding compliance. Medicare audits, including RAC and Target Probe and Educate, frequently review paid claims for accuracy, often using methods like statistical sampling, which can greatly increase recovery demands. Commercial payer audits vary by contract, with differing appeal processes and time limits that providers must understand.<br /><br />Key recommendations include maintaining rigorous compliance programs, accurate documentation, and correct billing to minimize audit risks. Upon receiving an audit notice, providers should carefully review requests, meet deadlines, and consider legal counsel for privileged investigations. Engaging qualified auditors and specialty experts to review records helps identify issues, prepare responses, and strengthen appeals. Providers should avoid onsite visits by auditors by sending records securely and retain meticulous copies of all submissions. Understanding Medicare’s multi-level appeals, from redetermination to administrative law judge hearings, and commercial payer appeal rights is critical.<br /><br />Ultimately, proactive preparation, expert collaboration, and thorough documentation enhance the likelihood of favorable audit outcomes. Audits, while challenging and costly, are considered a "cost of doing business" that require early intervention and continuous compliance efforts to protect the practice’s financial and legal health.

Keywords

physician resilience

inner well

growth mindset

purpose and relevance

sense of belonging

Eisenhower matrix

time management

burnout prevention

self-care and systemic change

Payer Audits

Medicare Audits

RAC Audits

Target Probe and Educate

Billing Compliance

Medical Documentation

Audit Appeals

Healthcare Legal Counsel

Audit Preparation Strategies