Payor Audits & Overpayment Appeals

Healthcare providers regularly receive medical record requests and overpayment demands from various payors, including Medicare and Medicaid, and commercial health insurance plans.

Although many of these requests are “routine” in nature and do not lead to any adverse findings, the consequences of an inadequate response could be devastating, as these audits often lead to significant overpayment liability and could also lead to administrative sanctions such as exclusion or revocation.

We regularly assist healthcare providers of all types of sizes in connection with with payor audits and overpayment appeals, including those involving government payors such as Medicare and Medicaid, as well as commercial payors. This includes assisting providers in responding to requests for medical records, as well as appealing unfavorable overpayment findings through the administrative appeal process..

We have assisted clients with all types of payor audits, including those involving pre- and post-payment review, overpayment disputes, exclusion and revocation, HIPAA compliance, EHR meaningful use, and various other issues. We have successfully handled audits from the contractor stage all the way through the appeals process. We pride ourselves in our deep understanding of healthcare regulations and billing/coding issues, which enables us to be a true partner to our healthcare clients, allowing them to focus on treating their patients.

If you need assistance with such a matter, please contact us today.