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Understanding Payer Audits With David Vaughn JD, CPC
Manage episode 334157265 series 2949848
Are you afraid of getting audited by insurance companies or Medicare? Do you get anxious when one of the payers sends you a request to audit 5 of your charts? Have you heard horror stories of the Feds knocking on a physician's door? Don't worry--you are not alone.
But not all audits are created equal.
Today David Vaughn joins me to discuss what you need to know about the different types of payer audits. David is both an attorney and certified professional coder and has been my healthcare attorney for 20+ years. David has been instrumental in helping my practice's billing compliance.
Here are some of the topics we discussed during our conversation:
- the difference between a benign audit and the one you should be worried about
- what to do if you get audited
- what your liability is with regard to coding
- the importance of self-audit
- how denials may give you insight into your audit risk
- the difference between federal payers and private payers
- in-network vs. out-of-network audit risks
If you are in private practice you will not want to miss this episode!
More about David Vaughn: David is one of a limited number of healthcare attorneys in the United States who is also a Certified Professional Coder®, certified by the American Academy of Professional Coders® (“AAPC®”).
David has served on the Legal Advisory Board of the AAPC and has written several coding and compliance books and manuals. He is also a national speaker on the legal implications of billing and coding. He also has a national healthcare law practice, and has represented over 2,000 physicians in approximately 40 states in over 10 physician disciplines. His practice consists of representing providers in federal and state prosecutions, qui tam cases, and Medicare and third-party payer audits. He also conducts audits and provides education to providers.
You can reach David at david@lalawfirm.net.
Want to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com
Join my FB group, The Private Medical Practice Academy.
Enroll in How To Start Your Own Practice and get the step-by-step process for opening your practice.
Join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice. The course, How To Start Your Own Practice is included in the membership, as a bonus.
Rate, Review, & Follow on Apple Podcasts"I love Sandy Weitz and The Private Medical Practice Academy Podcast." <-- If that sounds like you, please consider rating and reviewing my show! This helps me support more people -- just like you -- move toward the practice they want . Click here, scroll to the bottom, tap to rate with five stars, and select “Write a Review.” Then be sure to let me know what you loved most about the episode!
78 episodes
Manage episode 334157265 series 2949848
Are you afraid of getting audited by insurance companies or Medicare? Do you get anxious when one of the payers sends you a request to audit 5 of your charts? Have you heard horror stories of the Feds knocking on a physician's door? Don't worry--you are not alone.
But not all audits are created equal.
Today David Vaughn joins me to discuss what you need to know about the different types of payer audits. David is both an attorney and certified professional coder and has been my healthcare attorney for 20+ years. David has been instrumental in helping my practice's billing compliance.
Here are some of the topics we discussed during our conversation:
- the difference between a benign audit and the one you should be worried about
- what to do if you get audited
- what your liability is with regard to coding
- the importance of self-audit
- how denials may give you insight into your audit risk
- the difference between federal payers and private payers
- in-network vs. out-of-network audit risks
If you are in private practice you will not want to miss this episode!
More about David Vaughn: David is one of a limited number of healthcare attorneys in the United States who is also a Certified Professional Coder®, certified by the American Academy of Professional Coders® (“AAPC®”).
David has served on the Legal Advisory Board of the AAPC and has written several coding and compliance books and manuals. He is also a national speaker on the legal implications of billing and coding. He also has a national healthcare law practice, and has represented over 2,000 physicians in approximately 40 states in over 10 physician disciplines. His practice consists of representing providers in federal and state prosecutions, qui tam cases, and Medicare and third-party payer audits. He also conducts audits and provides education to providers.
You can reach David at david@lalawfirm.net.
Want to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com
Join my FB group, The Private Medical Practice Academy.
Enroll in How To Start Your Own Practice and get the step-by-step process for opening your practice.
Join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice. The course, How To Start Your Own Practice is included in the membership, as a bonus.
Rate, Review, & Follow on Apple Podcasts"I love Sandy Weitz and The Private Medical Practice Academy Podcast." <-- If that sounds like you, please consider rating and reviewing my show! This helps me support more people -- just like you -- move toward the practice they want . Click here, scroll to the bottom, tap to rate with five stars, and select “Write a Review.” Then be sure to let me know what you loved most about the episode!
78 episodes
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