Audits

Many payers are auditing providers. Many payers have contracts with services who are paid to recover overpaid claims. You may have seen payers requesting copies of your records. This is a precurser to a payer audit. If you receive these requests, you may want to consider utilizing PBMS’ skilled professionals who can identify any issues in your billing process which may result in an audit failure. Through these reviews, we can pinpoint insufficient documentation, coding errors, and more. By showing the payers that you have taken action to improve these areas, it can help in an actual audit, if they move forward with that. 

In addition to payer request records and/audits, you may request that PBMS perform independent audits on your current practice. This would be done for your benefit and for your compliance plan. PBMS can perform audits on the following items: