Summary

In this episode, Sean and Terry discuss the increasing prevalence of audits in healthcare, emphasizing the importance of being prepared and knowledgeable about compliance. They explore the challenges posed by third-party audit requests, the necessity of verifying the accuracy of cited policies, and the strategies for responding effectively to audit inquiries. The conversation highlights the need for vigilance and thoroughness in documentation and coding practices to navigate the complexities of healthcare audits successfully.

Takeaways

• Audits are inevitable in healthcare; preparation is key.
• Challenge audit requests and verify their accuracy.
• Documentation must be thorough and compliant with guidelines.
• Third-party auditors may misinterpret or misrepresent policies.
• Request extensions to ensure complete and accurate records.
• Clinical summaries can provide context for audits.
• Always check the validity of cited references in audit requests.
• Understanding the rules is crucial for compliance.
• Independent audits can help validate coding practices.
• Proactive communication with auditors can lead to favorable outcomes.