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During a recent Monitor Monday broadcast healthcare attorney David Glaser shed fresh light on commercial auditing.

Although private insurance audits used to be rare, but over the last few years, they seem to be on the increase, Glaser with the law firm of Fredrikson & Byron.  “The initial contact from a private insurer may ask you to submit written records or it may include a request for a site visit, “ he tells RACmonitor.

Glaser continues with his recommendations for the care and feeding of the auditor at your office in his own words.

When auditors are on site, you want to find a nice location that is out of the way. I would recommend going to considerable lengths to avoid having your staff interacting with the auditors.  Be friendly.  Offer food and coffee, but keep the hospitality limited to physical comfort, not social interaction.  I worked on an audit in New Mexico where the auditors left with original medical records.  That was a shock to me, and should go without saying that auditors should not be permitted to leave with any original records.  You will, however, want to have a good sense of exactly what they take.  If the auditors make copies, you may wish to make a second copy for yourself. 

When the auditors arrive ask if it is possible to have an exit interview when they complete their work.  If one is allowed, include your legal counsel.  Use the exit interview as a chance to determine whether the auditor had any concerns.  The exit interview also can be a good opportunity to learn about options for improving the quality of your records. 

Some basic preparation can make it easier for you to handle private payer audits.

Listen to David Glaser, Esq. on Monitor Mondays, 10 AM ET with his popular “Risky Business” segment.


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