An audit letter from a payer should never be ignored as there will be consequences for not responding. When presented with an audit, facilities should not ignore the request, identify the reason for the audit, reply in writing expressing willingness to cooperate and requesting details on claims and audit standards, reference CPT coding guidelines and have supporting documentation ready, and evaluate contracts and laws regarding audits.

1. THE IMPORTANCE of a timely and accurate response to any audit letter you may receive cannot
be stressed enough. If you don’t respond, there will be consequences.
Four Points to Keep in
Mind When Your Facility
is Presented with a Payer
Audit

2. While taking all necessary precautions, it is extremely helpful if your system has features that facilitates proper
documentation. MEDHOST EDIS utilizes charge capturing functionality that is based on documentation, resulting in a
more complete and accurate charge capture. A significant benefit of syncing charges with documentation is ensuring
an audit proof record so that in case of an audit, every charge is supported by documentation.
Some of points to keep in mind when your facility is presented
with an audit:
Do not ignore the request and identify the reason for the audit to define an
appropriate response.
Reply in writing to inform payers that you are willing to work with them and
that they must identify each claim in question as well as the detailed criteria
or standards for the audit.
Reference Current Procedural Terminology (CPT) coding guidelines and have
appropriate supporting records ready.
Evaluate your payer contract on audits and conflict resolution as well as
applicable state laws regarding audits and repayments.
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