Catherine Boerner (cboerner@boernerconsultingllc.com) is President of Boerner Consulting, LLC in New Berlin, WI.
Compliance officers tend to focus on Medicare and Medicaid compliance, but should not lose sight of Medicare Advantage Plans and Medicaid Managed Care Plans. There has been an increase in audits from the insurance companies that offer these plans. Compliance officers may want to seek out a process to make them aware on a regular basis what record requests are coming in to the Health Information Management (HIM) department from these Plans. Consider discussing with the Revenue Cycle Integrity team if and how they are tracking the results from these reviews/audits. Compliance officers can contribute to the discussion with revenue cycle in understanding any potential root causes from these recoupments/denials.
