There are a lot of things that you should be aware of when making sure that claims and billing are managed properly. There are two different types of billing audits: a prospective billing audit, and a retrospective audit. A prospective audit will be conducted by someone in the staff who has been assigned this role. This happens before the claims are submitted by the person paying. On the other hand, retrospective audits occur after the claim has been submitted and errors have been identified.
There may be situations in which an auditing company believes that a physician has over-billed their patients. If you are a medical professional who has been accused of over-billing patients, you may want to seek legal representation from an experienced medical defense attorney. You may be able to either settle or fight a claim, depending on the situation. Of course, your medical defense attorney will be able to guide you in the correct direction and tell you which option would be in your best interest.
Whether or not you have truly over-billed a patient depends a lot on what sample the auditing company is looking at. If the sample is very small and shows over-billing, it may not be entirely accurate to the bulk of the patients. However, if the sample is very large and shows mass over-billing, you may be in trouble.
Contact our firm today for dedicated legal representation during this difficult time.
If you require a medical law attorney for your legal matters, call Paul E. Walker, an experienced New York City OPMC & OPD Lawyer. Please contact the Walker Medical Law firm to set up a free initial consultation.