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How to Handle Healthcare Audit Defense?

While a healthcare audit almost always sounds like a good thing, there can be a bad side to it. If something goes wrong in your audit, you can be legally liable for a huge range of mistakes or healthcare errors – even if they are things that you are already working to resolve.

If you feel like you have been treated unfairly during an audit or that the audit process was somehow biased and did not include important details, then having ways to defend yourself and your business can be important. Given that more and more audit processes are using computer algorithms and relying on billing activity, some audits are coming from a place of suspicion rather than from fact.

Why Defend Yourself?

It is easy to just accept the outcome of a healthcare audit since most audits are carried out as a full, legal process. However, even if there was nothing wrong with an audit itself, you still want to defend yourself – a good defense can be the difference between paying light fines and having to almost bankrupt yourself.

This becomes even more important when you consider that not all audits are objective. They may have been done by a group that had a bias towards a certain business or who ignored a particular aspect of your company and focused exclusively on the red flags they already saw.

Learn About The Audit

The more you know about a given audit, the easier it becomes to understand how you can defend yourself. You will usually be told about an audit and given a copy of the findings, but it is still important to read between the lines and gather as much information as you can.

If you are going to prepare any kind of serious legal defense, then this becomes even more important. You need to have an in-depth understanding of what the audit found, how it was carried out, and any other specific details that may influence the kind of defense you can prepare for yourself.

Ask the auditor as many questions as you can, and consider getting professional support to help you pinpoint any burning questions that could be vitally important to defend yourself. Every scrap of information helps, but you also need to focus on the most important details if you want to succeed.

Hire Healthcare Audit Defense Lawyers

One of the most reliable ways to defend yourself after a healthcare audit is to seek legal representation. A good healthcare audit defense lawyer can provide a massive amount of support when you are working to try and defend yourself, often taking care of the tougher or more complex parts of the situation to ensure that it all gets done right.

The earlier you can hire a legal expert – or an entire legal team – the better. If you wait too long, you might not have enough time to fully focus on the important parts of the audit, let alone gather enough information to defend yourself properly.

Remember that there are a lot of layers out there and that you will always want to choose the best healthcare audit experts for the job. It can take some searching to find the right team, so make sure you find a team of experts that you know you can trust with the responsibility of defending you.

Set the Scope

One of the easiest ways to slip up is to not set any firm boundaries. You have rights when it comes to audits, and you can limit the scope of what the auditors can do. If they start to exceed their authority, you have a range of ways to rein them in and make sure that they are sticking to the audit itself.

This can be an important way to limit what they can inspect or who they can talk to. If you know a certain area of your business has problems and are actively working to fix them, you do not want to let auditors use the current lacking healthcare standards as a reason to double down on their audit.

Stay vigilant and be ready to invoke your own rights whenever necessary. An audit is generally only able to focus on the scope of whatever it was created to audit, and you can stop the auditor from snowballing their audit into a full-scale investigation. The more of your business they can cover, the more flaws and faults they will find – even if they are minor issues individually, you do not want a single audit mentioning them all at once.

Understand Your Rights

Aside from keeping the audit’s scope consistent, you also have a range of other rights that you can invoke when necessary. These are best explained by healthcare audit consultants, but they can really help if you are struggling to defend yourself again an unfair or scathing audit.

You can challenge negative audits through a five-stage appeals process, and doing so is a core part of actually defending yourself. Beyond that, you have a range of rights dictating how your business can be audited, as well as the right to learn about the results of the audit and challenge or question those results as needed.

Push for Compliance

One of the best defenses for dealing with any audit – whether they are MAC audits, RAC audits, or ZPIC audits – is to prevent them from finding anything bad in the first place. While it can be tempting to just “sweep the problems under the rug,” it is often better to just handle things in a direct, practical manner.

Creating a good compliance plan and doing your best to stick to it whenever possible can make it much, much less likely for you to actually trigger any kind of red flags. Even if you are in the middle of an audit, working to be more compliant can help reduce the number of issues your auditor finds.

If you are worried about having to defend yourself from audits, then call in audit and compliance specialists and start working on improving your overall compliance levels. If you can correct all potential issues ahead of time, then the audits are going to be far less of a problem, and you will not need to worry about defending yourself from scathing accusations or serious legal investigations.

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