Physician office audits

ADD1919

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BC of NY recently sent a letter to one of my doctors saying they wanted to review (and specifically wrote-- "This is not an audit") 55 charts and gave an estimated time of 6 hours beginning at 9PM-- has anyone heard of such a thing?
 

ARCPC9491

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Not in your state but they must tell you what they are doing with the records. Pull your contract ... it's in there.
 

ADD1919

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Office audit

Thanks so much for your prompt reply! I have never had this before, What did you mean they have to tell us what they want to do? They said they wanted to 'review" the charts- not udit them (isn't that the same thing? And the hours (9PM) seemed kind of odd. Is that what would be in the contract too?

Thanks again!!!!:)
 

ARCPC9491

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They have to specify what they are using your records for. They can't just say "give me 50 of your charts, I'll return them in the next 6 hours" Sorry, no dice. Not happening.

Any review/audit request is outlined in the provider contract with the insurance. Usually they give you 30 days to respond/appeal and the request must outline the reason for this "review"

For example, we get requests all the time for insurances wanting to "review" diagnosis codes against the records for the HCC coding.
 

em2177

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The 9pm might be a typo but I would double check the time with them. As far as them reviewing your charts, I dont see nothing wrong with that. Are they reviewing for the HCC Risk Adjustment project? You can ask them directly what it is for. An audit and a review are two different things. Make sure you are clear of what they are going to be doing with the charts.
 
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