Recived an Audit?
Help with Compliance?
Support for in-network and out-of-network providers. Payors of all kinds have an obligation to monitor the community for fraud & abuse. Once you receive notice of a payor audit you have an opportunity to review compliance, negotiate any errors and avoid sanctions.
Your team will work alongside ours, from your billing & coding staff to in-house counsel in some cases to do a risk evaluation and analyze your exposure for the audit period.
We take the time to do a full diagnostic and prepare for follow-up activity before we respond. The goal is to prevent soft flags and keep your business flowing throughout the audit process. We believe that open lines of communication are essential for all sides to work through an audit quickly and efficiently.
- Medicare/medicaid Audit
- Payment Suspension
- Commercial Plan Audit
- Rac Audit
- Care & Quality Improvement Audit
- Medicare Appeal
- Zpic Audit
- Dea Audit
Our experienced attorneys routinely assist clients in identifying areas for improvement
- We analyze risk in billing practices
- We identify documentation and systems that validate a claim
- We challenge overpayment demands and allegations of fraudulent billing
- We provide representation on denied claims, false claims or overutilization of services.
Corrective Action Plan Implementation
Policies & Procedures Development
Healthcare providers need to have in place certain policies and procedures in order to allow providers to maintain compliance with the law; assure periodic assessments of areas of risk; and respond appropriately when a breach is suspected or detected. Our most proactive clients develop policies & procedures to avoid audits and red flags.