Medicare Part C audits for Medicare Advantage plans are coming and there are no overall limits on number of records or the timeline in which records can be reviewed. However, hospitals and other providers will be able to limit audits in negotiations with plans. In her blog, Lori Brocato, audit product manager at HealthPort, suggests five areas where providers should seek limits on audits when they negotiate contracts with plans.
1. Number of medical records that can be reviewed.
2. The time period records are available for review.
3. Types of records involved in audits. For example, if the hospital is not being reimbursed on DRGs, rule out DRG audits.
4. Number of third parties reviewing your payments.
5. The information that can be requested, in order to limit the potential of HIPAA breaches.
6. Timelines for review and appeal.
7. Set reimbursements for document production and mailing.
Read the HealthPort Blog by Lori Brocato.
1. Number of medical records that can be reviewed.
2. The time period records are available for review.
3. Types of records involved in audits. For example, if the hospital is not being reimbursed on DRGs, rule out DRG audits.
4. Number of third parties reviewing your payments.
5. The information that can be requested, in order to limit the potential of HIPAA breaches.
6. Timelines for review and appeal.
7. Set reimbursements for document production and mailing.
Read the HealthPort Blog by Lori Brocato.