—Jeffrey Randolph, Esq.
ANJC Legal Counsel

The top two revenue-boosting wells for payers, i.e., recruiting new members and raising premiums, are drying up. Premiums increased disproportionately beyond inflation and workers' earnings growth in 2001-2006 (health insurance premiums – 65.8%, inflation – 16.4%, workers' earnings - 18.2%).

Premium wars preclude insurers from further raising rates, and recently enacted timely payment laws limit how long they can withhold repayment to earn interest as they had in the past.

To meet profit expectations and still play within the new rules, insurers must go after the reimbursements that were already paid.

Download the full article:
The "Business" of Healthcare Provider Audits
How Payers Are Getting Away with Practice Murder

Table 2. Audit Triggers – Profiling Methodology   Stage Report   Prepayment Review CCI and LMRP rules Inter-claim, intra-claim, cross-claim Lifetime duplicates Date range duplicates Re-bundling Modifier codes E&M crosswalk Visit level   Post-Payment Audit Procedure repetition High payments per day Surge analysis Unusual modifiers Unusual procedure rates Geographic improbabilities 5/50 patterns   External Resources Providers watch lists OIG sanctions databases High-risk address databases	The risks of noncompliance have changed too from money return to exclusion from government programs and loss of practice license. Administrators can be barred from working in the healthcare industry and clinicians, managers, corporate directors, even outside consultants can be jailed for healthcare fraud and abuse. The federal government strongly encourages health compliance programs and promotes voluntary compliance and self-policing in a variety of ways. The existence of a compliance program may determine whether the matter can be routinely handled as an overpayment by the payer or it must be investigated by the OIG, or even referred to the Department of Justice to be pursued as a civil infraction or as a criminal matter.
Now you can reduce audit risk and avoid audit threat by preparing for an audit: Integrate disciplined visit documentation procedures using SOAP notes. Monitor audit trigger red flags in real time. Track claims that might offend national or local frequencies for specific CPT codes. Contact Billing Precision for a demo today to discover how you can protect your practice. Billing Precision works hard to increase your collections, reduce audit risk, improve your productivity, and focus on building your practice using powerful methodology and a single, completely integrated system. Our approach is timed to meet your objectives and to adapt to your evolving priorities. The bottom line is that your audit exposure shrinks as a result of rigorous teamwork between your office and our team. Explore our methodology to discover how hundreds of office managers and doctors just like you have been delighted. "ANJC pays close attention to industry leaders who are positioned to help chiropractors in being more successful with challenges of every day practice. I am very pleased that Billing Precision services assist ANJC members with billing and collections, expediting revenue cycle, helping manage compliance, and integrating front and back office workflow." - Sigmund Miller, DC, Executive Director, Association of New Jersey Chiropractors “Billing Precision gets chiropractors paid. It uniquely embraces the vision and system required for successful high volume practices.” -Drs. Ben Lerner and Greg Loman, Founders, MaximizedLiving Read Case Study >> “Billing Precision's team is obsessed with getting chiropractors paid. Its technology is the backbone of my practice, which is now completely paperless.” - Charles Majors, DC, Planet Chiropractic, Romeoville, Illinois 1,500 patient visits per week "I know of practices that were asked to return years of payments after a random audit. Billing Precision pays enormous attention to every opportunity to reduce audit exposure. Their performance is outstanding." - Doug Cassel, MD, Director of Interventional Radiology, Hoag Memorial Hospital, Newport Beach, California “In two months we caught up with my backlog and my 120-day Accounts Receivable shrank to 4.4%. This translates to almost 20% in added revenue.” - Greg Loman, DC, Trinity Chiropractic in Naples, Florida Read Case Study >> “Billing Precision delivered. Clean claims, measurement and analysis yield greater collections.” - Ben Lerner, DC, Celebration in Kissimmee, Florida Read Case Study >> "Billing Precision has uniquely adapted Wall Street methodology to healthcare claims processing, resulting in dramatic A/R reductions and new revenue recovery for the medical practice." - Bob Ettl, Managing Director, Allianz Asset Management, Newport Beach, California “Billing Precision is an industrial strength billing solution for the family size practice. I get paid in 7 days for what used to take more than 90. It helps me daily to focus on patient care and grow my profitability.” - T. Foster Bryant, DC, Jubilee Family Chiropractic, Naples, Florida "Billing Precision goes beyond making sure we are paid in full and on time - their leading edge chiropractic billing software has turned my entire office into a completely paperless and compliant operation, so I can focus on my patient health and practice growth." - Michael Lagana, DC, BackSmart Wellness Center, Edison, New Jersey "No insurance offers protection against audit risk, which carries enormous potential penalties.  Billing Precision's unique chiropractic billing software reduces audit risk and streamlines SOAP note compliance management." - Jeffrey Randolph, Esq.  ANJC Legal Counsel "I can not speak highly enough of these guys and their chiropractic billing software.  Billing Precision has revolutionized the way I practice and my collections have gone through the roof.  The more you embrace Billing Precision technology the more it will  do for you.  I do not think there is a better overall chiropractic office management system available." - Robert White, DC, True Health Chiropractic, Springfield, New Jersey  Read More Testimonials >> Billing Precision's founders hold advanced degrees in chiropractic, computer engineering, and mathematics, and were awarded several patents in artificial intelligence and information security. Our core team has a deep understanding of the needs of chiropractors and the challenges we all face in the current healthcare environment. To achieve maximal effectiveness of Billing Precision's compliance program, our system developers teamed up with Jeffrey Randolph, Esq., the ANJC Legal Counsel. To hear Dr. Sigmund Miller, Executive Director of ANJC, interview Jeff Randolph, click here. For more information, join Interactive Online Audit Risk Seminar.

Our billing system uses centralized technology serving hundreds of stand-alone billing services and healthcare clinics. With its emphasis on centralized tracking of payer performance from a single point of control, shared coding and audit compliance rules, and accountable teamwork, our system helps every doctor using it to manage practice audit risk.

A key difference between Billing Precision and thousands of other billing services is that we all—including every Billing Precision client and our entire staff—share, use, and continuously enhance our technology platform and processes. Through this shared platform, Billing Precision's team becomes a virtual extension of your practice. Billing Precision seamlessly extends your staff and gives you powerful control over your practice workflow and billing productivity.

Contact Billing Precision for a demo to discover how you can protect your practice.

The federal Department of Justice, the Office of Inspector General (OIG) at the Department of Health and Human Service, state Medicaid fraud control units, and other enforcement agencies have brought multiple enforcement actions against various healthcare practices - even small practices - over the course of the past twenty years

The institutional risks of noncompliance have grown since 1995 from relatively non-adversarial audits and occasional return of payments to formal investigations, prosecution under the False Claims Act, and whistleblower action.

The personal risks of noncompliance have changed too from money return to exclusion from government programs and loss of practice license. Administrators can be barred from working in the healthcare industry and clinicians, managers, corporate directors, even outside consultants can be jailed for healthcare fraud and abuse.

The federal government strongly encourages health compliance programs and promotes voluntary compliance and self-policing in a variety of ways. For instance, in the case of Medicare and the OIG, the existence of a corporate compliance program influences the approach to a violation of a federal requirement in terms of an innocent mistake or a fraudulent act. The existence of a corporate compliance program may determine whether the matter can be routinely handled as an overpayment by the payer or it must be investigated by the OIG, or even referred to the Department of Justice to be pursued as a civil infraction or as a criminal matter.