Every day, hundreds of healthcare providers receive requests for additional documentation. In most cases, such requests include inquiries on the medical necessity of services or any other paperwork specific to a single appointment. Usually, the requested documentation gets processed quite quickly, and claims simply get paid in full. However, if such requests become systematic, insurance carriers may suspect an inconsistency in a provider’s billing pattern, or what is even worse – a payment integrity audit.
Internal audit – a key to preventing revenue losses