Protect Your Practice Against Payer Audits with These Preparedness Strategies

Cheryl Toth, MBA

Protect Your Practice Against Payer Audits with These Preparedness Strategies
Healio ⋅ Orthopedics Today – September 2018
by Cheryl Toth, MBA

The top two things that can trigger a payer audit are computer algorithms and coding outliers, according to attorney Patricia Hofstra, a partner at Duane Morris LLC.

“It’s almost guaranteed that if you bill a lot of one CPT code, it will eventually trigger an audit,” Hofstra said. “There may be nothing wrong with your coding and documentation, but you will be subject to more scrutiny.”

That is because payers run claims through analytics systems to identify patterns that are outside of the bell curve, Hofstra noted.

“If you perform a high volume of total knee arthroscopy compared to your peers, you are going to be an outlier of that CPT code, and outliers get audited,” Hofstra said.

If there is a potential audit in your future, there is no better time than now to be prepared. Here’s how to do that.

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