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Payer Audit Defense Services

Solutions

Payer Audit Defense Services

MRO offers a variety of services to defend our clients against the rising tide of government and commercial payer audits.

Audit compliance services

All MRO Release of Information (ROI) clients receive special, value-added audit compliance services to help reduce or eliminate the workload associated with government or commercial payer audits.

How we ramp up your payer audit compliance:

  • Government audit requests and appeals letters are designated with priority status, added to a priority-processing queue and receive special handling by a dedicated audit team.
  • Additional Quality Assurance (QA) checks are performed on audit requests, including deadline and address verification and expedited fulfillment.
  • Selection of appropriate delivery method for each request, including esMD electronic delivery to Centers for Medicare & Medicaid Services (CMS).

Managed care contract support services

MRO works with hospital personnel to interpret payer audit language, including payers’ rights to obtain records for the purpose of paying claims, and other reasons, such as aggregating and analyzing records for risk adjustment. MRO also provides educational services to help organizations review and update contracts with the fair and compliant language specific to obtaining medical records for post-payment audits, and offers specific verbiage for inclusion in contracts.

Centralized supplemental audit services

MRO’s centralized Remote Services team assists clients in handling high-volume requests associated with government and commercial payer audits, including RAC/MAC and DRG coding review—all from the National Service Center.

MRO applies its ROI expertise to audit requests, offering logging services, ensuring authorizations are HIPAA-compliant and fulfilling release processes from the service center. Batch logging of requests into the ROI Online® system allows multiple requests– sometimes hundreds or thousands–to be verified and logged in minutes instead of days.

We can manage the entire audit process or only selected duties depending on your preference. For example, MRO can log ROI requests and release records only, or we can provide a full service, which includes creating correspondence and advanced processing.