Facing an insurance audit can be a daunting experience for physicians and practice managers alike. The crucial question that arises in such situations is whether to handle the process independently or seek the expertise of a medical attorney. This decision is influenced by various factors, and understanding the nuances can significantly impact the outcome of the audit.
Individual Comfort Level and Understanding
The first consideration revolves around individual comfort levels. Are you at ease providing all the required information? Do you comprehend the questions posed by the insurance auditor? Are you confident in interpreting the purpose behind a letter requesting medical notes, repayment, or an error rate report? Assessing your own comfort and understanding is vital in determining whether to directly engage with the audit process.
Outsourcing Decision-Making to an Attorney
Many providers and office managers opt to outsource the decision-making process and task of dealing with an insurance audit to a medical attorney. This approach is particularly appropriate when one is not fully prepared to handle the intricacies of interacting with an insurance company. Successfully navigating an audit requires a strategic, professional approach, coupled with an understanding of both state and insurance requirements, which may not be readily available to physicians and practice managers without the necessary experience.
The Catch-22 Situation
Insurance representatives and auditors often exploit the lack of expertise on the provider's end, using it to their advantage in what can be described as a catch-22 situation. Employing an attorney at the outset can provide invaluable insights into the risks involved and guide the provider through the journey ahead during the audit process.
Experienced Guidance for a Complex Journey
For those unsure about handling an audit independently, especially if it's their first time or if they have always worked with an attorney, restarting the process with legal representation is a sensible solution. Expressing concerns to the billing company can also shed light on the best course of action. Hiring healthcare attorneys has proven to be a reliable solution for providers dealing with audits, coding challenges, appeals, and any rejections by insurance companies.
