How to Respond to a Payor Audit: Medicare and Beyond
How to Respond to a Payor Audit: Medicare and Beyond
Availability
On-Demand
Access expires on Dec 31, 2026
Cost
Resident/Student: $20.00
AOA Member: $60.00
Non-Member: $85.00
Military: $20.00
Retired: $20.00
Affiliate/Allied Health Professional: $0.00
Staff: $0.00
Credit Offered
1 AOA Category 2-B Credit
OVERVIEW

For a provider of healthcare services, payor audits are always a possibility. Government payors and commercial insurance companies rely on pre- and post-payment medical record and billing audits to determine whether provider services were medically necessary, accurately billed, and appropriately paid. Over the past few years, Medicare significantly increased the types and numbers of audits and outsourced many of the record reviews to private companies. With so many of these private companies conducting audits on behalf of the Medicare program, it is not a matter of whether a provider will be audited, it is a matter of when. To help alleviate some of the tension surrounding the audit process, providers must be proactive and understand what types of audits exist and how to prepare for the possibility.

Speaker: Vicki Myckowiak, Esq.



OBJECTIVES
  • List the types of payor audits
  • Review Medicare and Commercial Audit processes
  • Implement best practices for responding to payor audits record requests                        
  • Outline the payor audit appeal processes


Expiration Date: December 31, 2027

The AOIA designates this activity for a maximum of 1.0 AOA Category 2-B Credit. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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