INSURANCE REIMBURSEMENT AUDITS
Orange County Toxicology is available to manage to process of performing a audit of your current and past insurance reimbursements. Generally, insurance reimbursements audits are performed by an outside audit firm and are preformed on a contingent fee basis to ensure that the audit results in additional cash flow for you and your business.
Insurance Audit Details
Insurance reimbursement audits are generally performed to ensure the appropriate payments have been received by insurance companies and also compliance with all applicable laws. The audit process for both treatment centers and medical practices can be burdensome but it will typically yield additional funds from previous insurance claims, improved claims management processes, and also better compliance with applicable laws. Most services companies that perform insurance reimbursement audits use a contingent fee billing model, meaning that if no additional insurance payments are both identified and received there is no fee. Contingent fee rates for the performance audits at treatment centers and medical practices typically range from 20% to 30% of the additional funds identified and received from the insurance company.
What Are the Steps In An Insurance Company Audit
The process of auditing your insurance reimbursements can be burdensome but with some planning and the right provider is can be done simply and effectively. the insurance audit process generally includes:
- Determining what staff and audit firm will participate in the audit.
- Will retrospective period will the audit cover.
- What sample size will be initially selected.
- What types of audit and reimbursement risks should be examined.
- Was the service performed and documented correctly.
- Is the physician and practice information information correctly listed.
- Were the claim codes accurately reported.
- Was the patient and service information accurately reported.
- Was the appropriate reimbursement received from the insurance company.
A qualified insurance audit reimbursement firm will assist you in determining all of the above and will submit claims for any incorrectly reimbursed payments. It is not uncommon for insurance reimbursement audits to identify 10% or more of recoverable insurance billing.