Have a plan and process in place to help you through
Many medical plans (Medicare, Tricare, etc.) as well as managed vision plans (VSP Vison Care, EyeMed Vision Care, Davis Vision, etc.) have an ongoing process to audit payments to providers.
The audits can be random or can be targeted to your practice due to billing patterns that fall outside the norm. Insurance companies use big data analytics to compare what and how you bill your services.
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If you are an outlier, chances are you will be the target of an audit.
To protect you and your practice, it is important to have a plan and process in place in the case of an audit.
Our practices have been audited numerous times and having a plan in place helped us get through it.
Here are ten tips to help you survive an insurance audit at your practice.
1.Know the rules
Have you read your vision plan contract? I ask that question on a regular basis when I am lecturing on the topic of billing and coding.
For many offices, managed vision plans make up 70, 80, or even 90 percent of the patient base and revenue.
What is the percentage in your office?
How can you run a practice with the majority of your revenue coming from a source for which you have not read the contract?
2. Don’t assume a records request is routine
Some record requests and audits are routine. Others are not routine at all. This is why it is important to provide the insurer with the correct information within a timely manner.
There might be some hints in the insurer’s record request.
For example, if every record requested by an insurer involves a patient with diabetes and a specific code—that’s a strong indication that the request is a targeted search on that code.
In contrast, if the request covers a seemingly random number and type of patient—it’s probably a routine audit.
See full story at optometrytimes.modernmedicine.com