Among the greatest concerns busy doctors have is the POST payment audit. Dr. Lewkovich tackles the questions what criteria Auditors use to investigate.
Post payment audits is a financial bonanza for carriers. Doctors react too quickly and pay bizarre amounts unnecessarily - without a sober overview. Auditors however, choose targets that are supposed to bring a high rate of return. The Rule is that for every $1.00 spent for auditing, the audit should bring back $5.00.
That's important to know. Auditors will not chase a tough target.
Some of the criteria used by Auditors include:
- Unusually high per treatment costs
- Extreme frequency of care
- Number of total visits are very high
- Daily use of E & M codes not appropriate
- Daily use of cold packs
- Using 99215