Payer Audit Services at MAS
Do you receive audit requests for records from commercial insurance payers? Perhaps from a commercial payer, Medicare, Medicaid, an agency and you’re not sure how to respond? Are your payer audit submissions unsuccessful? Did you know that the most common error is missing records that were not produced? Not sure how to appeal if all the records were not provided in the audit request? Wondering how to prevent overpayment assessments associated with audits?
Although Commercial Insurance Payer Audit Services can be confusing, the main objective of payer audit services is to detect and prevent fraud, waste, and abuse in healthcare transactions. This helps to ensure that healthcare costs remain reasonable and that patients receive high-quality care.
Payer Audit Services can be overwhelming so it helps to have an expert at your fingertips! Let us help you smoothly navigate through your Payer Audit challenges.
MAS Helps with Payer Audit Challenges
At MAS, we can help with Commercial Payer Audits by reviewing healthcare claims and payments made by insurance companies or other payers to healthcare provider materials and policies. Our audits will ensure that the payments made by the payers are accurate and in compliance with the healthcare industry’s standards and regulations. The audits can be performed by the provider themselves but oftentimes it’s easier to outsource the work to third-party auditing firms that specialize in healthcare auditing services like MAS. Oftentimes, we do these payer audits alongside your healthcare attorney.
We are very experienced with providing record requests. We can review your packet and determine what information was not gathered which can reduce the overpayment request. It is much better and cheaper to get us in at the first submission.
Why is it cheaper when your staff could respond? Oftentimes, they do not pull all the records needed and that results in negative findings from the payer. Once you get to the last hurdle of the appeals process, we are not magicians. We have much better results the earlier we are hired onto a project.
We, however, are capable of jumping high hurdles when necessary – we recently completed a project with legal counsel and managed to reduce the overpayment request down to 1/4 of the original request of $480k. In another recent case, there was a $90k overpayment request where the payer used the wrong policies or quoted things in the policy that were not there; this overpayment was dramatically reduced also.
Once we produce the research and response, sometimes the “inquiries/investigations” get dropped. It really does help to have a expert by your side!