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Audits: Payors, Payors Everywhere!

Auditors need to be more aware & competent than ever before. No longer can healthcare organizations live on just Medicare: Medicaid & commercial payor awareness is necessary.

Commercials are tough. The ever–changing rules from commercial payors make it very difficult. Plus, unlike Medicare, commercial payors don’t typically provide solid rules – healthcare organizations have to piece the rules together themselves. And commercial payors generally have a poor way of communicating their rules to auditors

Auditor tip: When reviewing claims make sure that you review them from the perspective of the payor on the claim.

What are your experiences with meeting commercial payors’ requirements for reimbursable claims?

(The above was written by Bill Malm, N.D. R.N. CMAS… and Craneware Senior Data Product Manager. Bill was recently voted Auditor of the Year by the American Association of Medical Audit Specialists (AAMAS). Congratulations, Bill!)