Payor Disputes And Audits Observations Strategies

First Healthcare Compliance hosts Courtney Tito, Esq., Member, of McDonald Hopkins LLC, for an interactive discussion on “Payor Disputes and Audits: Observations & Strategies.” This presentation will help participants better understand the payor audit process and prepare the organization to respond. From recognizing the significance of initial correspondence, to responding effectively to initial and subsequent rounds of review, the presentation will take participants through the payor audit process from a government perspective and compare and contrast typical government audits with typical commercial audits. Finally, the presentation will identify some best practices that labs can implement now to prepare for payor audits.

Objectives:

1. Describe the government audit process - from initial correspondence through the various stages of appeal and share speakers’ experience with respect to commercial payor audits – what is similar and what is different from government audits.

2. Discuss the provider's responsibilities with respect to the medical necessity of testing for which it is submitting claims.

3. Identify steps providers can take to prepare for audits prior to an audit being initiated.

First Healthcare Compliance, LLC offers the most comprehensive cloud-based software solution to address the compliance program management needs of private practices, hospital networks, healthcare billing companies, and long-term care facilities. Our flexible and scalable solutions allow organizations to share, track, and manage their compliance processes with ease, view compliance in real time across all locations, and have peace of mind that they are current in all federal healthcare regulatory areas.

Administrators using the First Healthcare Compliance platform are able to share, track, and manage their compliance processes with ease, view compliance in real time across all locations, and have peace of mind that they are current in all areas.

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