Few pieces of mail cause as much heartburn among physicians as the dreaded audit letter from a third-party payor. Your first reaction may be a vision of a six-figure refund demand. Worse yet, you may treat the letter as a nuisance and not give it the attention it deserves. Post-payment review audits are a fact of life in medical practice, and with the proper preparation and response, they do not have to be disruptive or catastrophically expensive.
Each payor has its own audit, refund and appeal mechanism. This series will focus on the protocols currently in place by the major payors in Western Pennsylvania. The first installment will look at Highmark Blue Cross Blue Shield.
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