Insurance companies have been using computer technology to target providers with greater effect, but not always with the correct result. If you are a specialist who utilizes a set of medical codes more than any other codes, or more than anyone else in your area, your practice may be at risk for being targeted for an audit or worse, a demand for overpayment.
An overpayment demand will not likely occur until after you fail an audit. The best ways to pass an audit are: (a) ensure that your coding is compliant with all third party payor regulations and policies, and (b) maintain patient charts that accurately and completely reflect the medical necessity for any professional services performed, that the services were actually performed and that the services align correctly with the CPT codes billed.
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