Wiki Outside Audit

[livininthegray]

About 4 months ago we had an independent co. come and do and audit for a Med. Advantage plan and now they are requesting to do another audit of the same charts and same time frame. Do I have to let them do the re-audit? Where would I look for any rules that may apply to whether or not they are allowed to do a re-audit of our charts. This is very time consuming for us to pull over 100 charts. I have not talked with the auditing co. as yet as to why the re-audit, but if the re-audit is because there people did not do it correctly the first time am I legally obligated to allow the re-audit?

 

[LindaEV]

Whatever the reason, you could be obligated. Might be a good idea to check your contract with that specific MA plan.

I would definitely call this company and ask why they are doing the same charts for the same time period...that definitely doesnt make sense. You might luck out and it be an error.

 

[Lisa Bledsoe]

Was this an HCC audit? If so, all they are looking for are specific diagnoses so that the MA can get more money from Medicare. Pretty much a benign audit. Regardless, I believe you are obligated to follow through but definitely get more information as to why the repeat audit is needed.

 

[livininthegray]

I talked with the Med Adavantage representive and the reason for the re-audit is because there auditor did not collect the correct data. Would it be unreasonable to charge a fee and if so what can if anything can I do if they refuse?
No this is not a HCC audit.