Healthcare Organizations Should Expect a Surge in Managed Care Audits and Reviews in the COVID-19 Aftermath
by Greg Ford | Sep 28, 2020 | Feature Articles
by Greg Ford and Dawn Crump
Before COVID-19, healthcare organizations were experiencing a steady influx of audit activity from health insurance companies. Audits conducted both before and after payment coupled with HEDIS/risk adjustment reviews represented about 30% of the medical records requested in the first quarter of 2020.
Immediately following the outbreak of the COVID-19 pandemic, many providers, including hospitals and physicians, experienced a break in payer reviews and audits.
In his role at MRO, Ford serves as a liaison between MRO’s healthcare provider clients and payers requesting large volumes of medical records for purposes of post-payment audits, as well as HEDIS and risk adjustment reviews. He oversees payer audit and review projects end-to-end, from educating and supporting clients on proper billing practices and procedural obligations, to streamlining processes that ensure timely delivery of medical documentation to the requesting payers.