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American Association for Physician Leadership
American Association for Physician Leadership

Use These Preparedness Strategies to Protect Your Practice Against Payer Audits and Increase Revenue

by Debra Cascardo, MA, MPA, CFP

February 8, 2019


Summary:

In order to get paid for the work they do, doctors and their staffs must stay informed regarding all the new regulations presented by the government and third-party payers. Audits improve the chances that your group is compliant with Federal and state regulations, and internal audits can infuse newfound cash into the practice by discovering revenue loss.



Abstract:

The old caveat “If it isn’t documented, it wasn’t done” applies even more in this era of electronic health records (EHRs) and data analytics. Insurance companies deny claims for myriad reasons, and the Medicare Fraud Strike Force Teams use data analytics to prevent and combat healthcare fraud, waste, and abuse. If you bill a lot of one CPT code, it is almost guaranteed that it will eventually trigger an audit. There may be nothing wrong with your coding and documentation, but you will be subject to more scrutiny because payers run claims through analytics systems to identify patterns that fall outside the bell curve. There are many audits available that you can perform, including the Occupational Safety and Health Administration, Corporate Compliance business associate agreements, HIPAA, and revenue cycle management.


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Debra Cascardo, MA, MPA, CFP

Principal, The Cascardo Consulting Group, and Fellow, New York Academy of Medicine; phone: 914-358-9553; fax: 914-358-9554; e-mail: dcascardo@aol.com

For over 45 years.

The American Association for Physician Leadership has helped physicians develop their leadership skills through education, career development, thought leadership and community building.

The American Association for Physician Leadership (AAPL) changed its name from the American College of Physician Executives (ACPE) in 2014. We may have changed our name, but we are the same organization that has been serving physician leaders since 1975.

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