Sept 4, 2013

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Analyzing Overpayment Audit Results:  How Accurate Is An Audit Extrapolation?

Overpayment recovery audits are becoming more commonplace. However, the process utilized by payers to calculate the overpayment amount is both poorly understood and rarely challenged.

Healthcare consultant Frank Cohen of Frank Cohen and Associates is working to educate providers on the number manipulation game going on during overpayment audits. During a recent presentation on post-audit mitigation, Cohen explained that there are a number of different ways that auditors can bias the statistical analysis against the provider, resulting in a higher overpayment amount than might be statistically justifiable. . . .

Continue reading this article at AppealLettersOnline.com

AppealLettersOnline.com Featured Letters

We've developed a request letter (referenced above) to assist organizations with requesting additional information related to audit results.  This letter is meant to serve as a "Information Request" letter and is not meant to serve as an appeal letter and is not stored in our appeal letter database.  See the Audit Information Request Letter in the AppealLettersOnline.com Download Library.  The AppealLettersOnline.com Download Library also has a letter to request managed care contract renegotiation and a letter to confirm an offer from a third party repricing company.

Access the appeal letters at AppealLettersOnline.com


Denial Management:  Get Your Practice Ready For ICD-10

Tammy Tipton, President of Appeal Solutions, explains how to track hidden denials for optimum financial performance in an upcoming presentation for the Illinois MGMA Payer Conference on Oct. 25th.  Providers must clean up accounts receivables now and also focus on poor payer claim processing performance.  The presentation covers the following denial management appeal best practices critical to reimbursement security in the coming months:

  • Tactics to better identify "hidden denials" and tips to better track them in order to improve your ICD-10 readiness.

  • What types of denials will likely be impacted by ICD-10 implementation and how to prepare an optimum ICD-10 denial management strategy.

  • Best practices for writing appeal letters, including how to demand disclosure of ICD-10 claim decisions and what to do about uncooperative payers.

Contact Tammy Tipton at t.tipton@appealsolutions.com if your chapter is looking for an educational presentation specifically designed to empower providers to protect reimbursement during the ICD-10 implementation. Tipton will also custom a presentation to a specific organization's needs and work with your ICD-10 implementation team to improve denial management in conjunctions with ICD-10 implementation.

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