Understanding Prepayment Audit Reviews  

Category: Auditing

By: Mathew J. Levy, Esq.
Stacey Lipitz Marder, Esq.
Kern Augustine Conroy & Schoppmann, P.C.

The unfortunate reality is that the cost of running a medical practice is increasing while reimbursement from third party payers is decreasing. In order to survive, it is crucial that physicians get paid for the services rendered to their patients in a timely manner. In today's climate, insurance companies are engaging in several tactics in order to make it more difficult for physicians to receive proper reimbursement. In addition to overpayment demands , insurance carriers are delaying and making it more difficult for physicians to get paid through prepayment audits. Being placed on prepayment audit review is extremely frustrating for a physician, and can ultimately have a devastating impact on the operation of a practice. We have outlined a few key concepts...