Audit Defense for Physician Practices

CMS, CMS contractors and private payers are increasingly performing audits of coding and billing practices.  The Justice Department estimates that over $30 billion dollars a year are lost by the government to fraudulent healthcare practices.  The current administration has made recovery audits a priority for the past several years.

An audit may result in administrative fines or in some cases criminal allegations.  HCIT Consulting has extensive experience working with practices to review audits performed by contractors and external consultants.  We provide the following services:

  • Documentation review by an independent physician who is also a certified professional coder (CPC)
  • Review of supporting guidelines (e.g., LCDs, CMS guidance, private payer requirements, etc.)
  • Detailed factual rebuttals of negative audit findings
  • Development of evidence-based justifications based on a review of the scientific literature
  • Development of evidence-based protocols that include a review of the scientific literature and documentation and coding requirements provided by payers
  • Instantiation of these protocols into electronic health record content, clinical workflows, and documentation
  • Provider and staff education regarding best-practices and protocol adherence