Wiki UHC audit

[Blackhorse]

Our lab has received a letter from UHC to audit 60 patients for Covid testing. We found a few patients' DOS on the test reports don't match the DOS on the claim. We are not sure if the charge posting person entered the wrong DOS or incorrect collection date was posted by lab. What will happen to us if mistake was made either by charging or lab? Will this trigger another big audit? Will UHC stop all payment to us? Will this trigger audit from Medicare and other carriers?

 

[thomas7331]

Any time you discover a significant error, whether it's in the course of an audit or otherwise, the best practice is to submit a corrected claim to the payer immediately. If, as in your case, it's in the process of reviewing records to submit to the payer, I have usually also attached a cover letter to the records alerting the payer to the fact that you have become aware of the error and that you have already sent in the corrected claims.

In my experience, payers know that errors do happen and as long as it's not the type of error that suggests you are manipulating information in order to get payment that is not justified, it's not likely to cause you a problem. In the situation you describe, the payment would not change - just the date of service. As long as the dates were not changed to conceal a duplicate payment or to otherwise cause an overpayment, then I don't expect the payer will flag your provider for this.

 

[Blackhorse]

Any time you discover a significant error, whether it's in the course of an audit or otherwise, the best practice is to submit a corrected claim to the payer immediately. If, as in your case, it's in the process of reviewing records to submit to the payer, I have usually also attached a cover letter to the records alerting the payer to the fact that you have become aware of the error and that you have already sent in the corrected claims.

In my experience, payers know that errors do happen and as long as it's not the type of error that suggests you are manipulating information in order to get payment that is not justified, it's not likely to cause you a problem. In the situation you describe, the payment would not change - just the date of service. As long as the dates were not changed to conceal a duplicate payment or to otherwise cause an overpayment, then I don't expect the payer will flag your provider for this.

Thank you for your reply. I was told by my colleague that we can not send corrected claims now because we are under review now.

 

[thomas7331]

Thank you for your reply. I was told by my colleague that we can not send corrected claims now because we are under review now.

It's quite possible that is your organization's or your payer's policy. If so, that's what you'll need to do then, and 'let the chips fall where they may' and hope for the best!