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Audits are not uncommon in the healthcare industry. When you have businesses working together, everyone is trying to save themselves a bit of cash. So when an insurance provider, Medicare, or Medicaid believes that they are overpaying for a service or treatment, they may request an audit.
If you are audited by a Medicaid audit contractor, it is no reason to panic. An audit does not necessarily mean that there is a problem, but it does mean you need to be prepared to work with the auditors efficiently. To best cooperate with the audit, you will need to understand what it means and what is expected of you.
When a patient covered under Medicaid comes in for a treatment, they will be billed a certain amount for the service and procedure. When Medicaid receives the bill for the appointment, they must determine if the amount is correct or if they believe it is too high.
If Medicaid believes that the amount is not right, they may request a contractor perform an audit. A healthcare audit does not automatically assume that the medical professional purposefully overcharged for the service or committed fraud, they simply are looking for additional information on how that number was established.
When under audit, healthcare professionals will need to provide documents, explanations, and histories of charges and bills. This can help the auditor determine if the price is correct or if they overpaid.
There are various contractors that conduct audits, each with a different purpose. Because each contractor is looking for different information, they will work in different ways. This means that each audit a healthcare professional or medical practice undergoes, they may experience extremely different procedures.
Here are some of the main contractors who may perform a healthcare audit:
Because each of these contractors want a different outcome, it can be difficult to understand what they are looking for and how you should best comply. If you are under audit, you may want to work with a New Jersey Medicaid Healthcare Audit Lawyer.
When undergoing an audit, you need to provide all necessary information to the contractor auditing you. Because audits can vary so drastically and necessary information can change with each audit, you need to have a vast understanding of what the audit means.
A New Jersey Medicaid Healthcare Audit Lawyer knows the ins and outs of each kind of investigation and can guide you through it. To ensure your audit runs smoothly and efficiently, an attorney can help you determine what information is necessary.