Advocate at every level

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Friday, February 22, 2019

LAS VEGAS - Audits aren't going away, but providers who are proactive vs. reactive will see better results, says Juliet McBride, partner at King & Spalding LLP. During her session at Medtrade, "Tackling a Probe and Educate Audit, UPIC/ZPIC Audit, Medicaid Audit and Other Contractor Audits: A Full-on Assault," McBride will share what providers should have in their toolboxes to respond to audits.

HME News: How are audits evolving?

Juliet McBride: If there's any good news at all it's that the contractors are open to listening to the provider community, but the challenges that remain have always been around, which is the volume of audits. And in certain instances, CMS has more opportunities to revoke billing privileges under its integrity program.

HME: What's a comprehensive game plan for audits? 

McBride: It's important to date stamp when you receive the audit so that you can defend if you’re already late in responding. The second thing that's really critical is having a team dedicated to addressing audits more regularly—meaning you have a team ready to call physicians for missing documentation, prepare comprehensive responses, and interface and interact directly with the auditing authority throughout the process.

HME: If attendees walk away from your session learning one thing about audits, what should it be?

McBride: Communication is key, both internally and externally. This means you’re starting to advocate at every level of the audit process with a company. You're picking up the phone and calling and trying to narrow the scope or you’re requesting an extension on timeline. Communication at every stage is critical because it really puts the arbiter on notice that you’re taking this seriously—you’re not ignoring them—you’re working on it and it shows a good faith effort to comply with what they’re requesting.