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  • Writer's pictureMichael Breslin

Audit Proof Your Business

Updated: Oct 21, 2020

Taking Control and Preparing for Payor Audits

Medicare, Medicaid, and Commercial Payor audits, unfortunately, are here to stay. According to the 2017 CERT report, CMS paid $390 billion in claims and paid $39 billion in error. Out of the $39 billion dollars;

  1. $64.1 billion was due to insufficient medical documentation

  2. $17.5 billion was due to improper coding

In a recent report, CMS reported that the error rate dropped from 9.5% in 2017 to 8.1% in 2018…but resulted in Medicare losing $31.6 billion.  Over the past six years, Medicare has lost more than $230 billion due to improper payments.

It’s no wonder that payor audits are here to stay.  Owners and executive leadership teams MUST begin to prepare their businesses for the continued wave of audits.  The healthcare industry has been much to slow in responding and getting ahead of this continued regulatory wave.

The cost for non-compliance is far more expensive that taking a proactive approach.  Those that fail audits subject themselves to the following possible outcomes:

  1. Increased Bad debt and write-offs…many that were avoidable

  2. Recoupments for up to thirty-six months

  3. Increases to Unbilled Revenue and reduced cashflow

  4. Business interruption due to a reactive audit plan

  5. Suspension of payments for 180 days

  6. 100% pre-paid audit of claims

  7. Revocation of your NPI

  8. Possible criminal prosecution where fraud is determined

For as little as $35, and a 100% satisfaction guarantee, you can avoid all the pain and begin to audit proof your business

As part of an effective corporate compliance plan, companies are expected to perform internal audits.  The problem is many companies do not have the time conduct these mock audits nor do they want to spend the time hiring auditors to conduct these mock audits either.

Boost Advisory Group are experts in helping to audit proof your business.  As part of our Mock Audit services, we will do the following for you:

  1. Work with the business owner(s) and/or the executive leadership team to identify the correct sample size of the audit; and

  2. Mock Audits are reviewed and managed by our licensed clinicians to ensure we are addressing all aspects of the clinical requirements; and

  3. Review all the medical records for each file; and

  4. Review AOB’s, ABN’s; and 

  5. Review refill notes where applicable for consumable products; and

  6. Review modifiers, bundled codes, billing codes, and technical billing requirements per LCD/payor guidelines; and

  7. Prepare comprehensive reporting that identifies any errors and/or missing documents or required elements; and

  8. Identify the drivers and suggest corrective actions to avoid these errors in the future.

Engagements can be on a one-time basis or we can handle the compliance reviews on a monthly basis so you can improve your corporate compliance plan and prepare your business for the upcoming audits…thus avoiding the pain and wave of emotions that a typical audit notification letter will cause.

We can even conduct outreach services for missing medical records so your current staff can focus on their day job; once again reviewed and managed by our team of licensed clinicians.

PLEASE don’t wait to find yourself in an audit and leave your destiny in the hands of a payor or outside contractor who is paid to recover funds.

ACT NOW!  Call us at 888-304-2480 or fill out our contact us form and we will contact you within 24 hours business hours. We guarantee your success!

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