What do you do if you get a network audit? An audit is when an insurance company like BlueCross BlueShield or some other company sends you a letter that states they want to take a look at your billing patterns, review some claims and treatment notes, or anything like that.
This can be a scary moment because if they find some issues, or claim there are some issues, they can come after you. I’ve seen doctors pursued by networks for several hundred dollars, and for over a million dollars, and that can devastate a clinic.
However, there are things you can do to avoid this in the first place.
First, avoid being an outlier. What does that mean? Well, if you treat more frequently than other clinics, or if you bill much higher for your services than other clinics, if you do things that look unusual, you are an outlier and are going to come to the attention of the networks.
Another thing you can do is keep very accurate records. Be an excellent book keeper. If you are audited the best thing you can do is contact a trusted healthcare attorney who has dealt with these audits in the past.
A healthcare attorney can let you know what options you have to deal with an audit. Sometimes there are issues of Erisa that are good defenses and sometimes there are other state law issues that provide you some protection.
When dealing with an audit you have to prioritize what’s important to you. Do you want to avoid the audit turning sideways and becoming a board complaint? Is it important for you to maintain your in-network membership?
These are just a few of the many things for you to consider. Because of that you will want to contact somebody that has experience in these matters and can give you a helping hand.
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