How To Prepare for An Insurance Audit

Insurance audits can be an intimidating prospect, but they’re necessary and, unfortunately, inevitable. Even if an insurer didn’t single your facility out for an audit, you may be part of a random selection. Whether you’re preparing for a pre-payment review or a post-payment review, the general purpose of an audit, from the insurer’s perspective, is to check for fraud abuse, and waste. There’s no such thing as a routine audit. They’re all a little bit different, but there are some things you can do to prepare ahead of time.

1. Words!

Read the language of the audit notification very, very carefully. Obviously, you’ll need to know timeline information and deadlines, but every audit is a little different and giving special attention to what they’re asking for can save you time. Why do they want the audit? What are they looking for? What documentation are they asking for? Make a list so you can tackle each part systematically.

2. Scope!

Focusing on the language leads us to the second step – scope. What does the audit include? What isn’t included? Your list of necessary items will help you get a handle on not only what is necessary, but how much of your facility will be impacted. You can determine who needs to be involved. How much help do you need? Do you need to loop in an attorney or compliance officer? Of course, your facility may consider every audit worthy of all-hands-on-deck, but if not, it’s good to be prepared.

3. Stuff!

Get all your stuff – medical records, invoices, and whatever else they’ve requested – all together in one place. If you need to have your physicians sign off on the medical records, prepare that too. If you’re missing something, it’s easier to determine that if you haven’t been sending information piecemeal. You may need to ask for a deadline extension, but once you have everything, you can conclude the audit.

4. Help!

A good option, when preparing for audits, is to get more people in your corner! We have several approaches that could clarify and improve the process. We can help you understand how CDM changes impact payers and how potential changes might disproportionately impact some payers, which might raise red flags. We can analyze how your decision-making will impact your payment from individual payers. We’ll look at your contracts closely and show you how a change in prices might affect your payment. If this change is too dramatic, it may trigger an audit. We also offer services to benchmark terms and help hospitals evaluate how payment changed through contract alterations from year to year.

Audits can be frustrating, and they’re often a huge amount of work, but, besides being necessary, they can provide a wonderful look at the health of your organization, as well as your data collection and storage systems. Being honest and comprehensive is the best way to give yourself, as well as the insurer, the best look at your facilities.

To learn more about how we can help give us a call at 888.779.5663 or contact us here!