Managing payer audits

Wednesday, September 6, 2023

Editor’s note: Sandy Giangreco Brown, MHA, BS, RHIT, CCS, CCS-P, CHC, CPC, COC, CPC-I, COBGC, PCS, and Diane Weiss, CPC, CPB, CHRI, will present “Managing Contemporary Payer Audits” on day two of the 2023 Revenue Integrity Symposium, which will take place on September 18-19 in Charlotte, North Carolina. Brown is the director of coding and revenue integrity at CliftonLarsonAllen, LLP. She manages and develops relationships, audit services, and education for clients, coding staff, and providers. Weiss is the vice president of revenue integrity and education with RestorixHealth, where she oversees several internal auditing processes as well as monitors all external payer audit activity and programs.

Q: In what ways does your session challenge revenue integrity professionals to think outside the box?

Brown: This session will encourage participants to be creative when it comes to managing their audit activity. It reinforces the idea that the simplest approach is often the best and easiest to implement and manage.

Q: What’s the biggest challenge in revenue integrity right now? How does your session help tackle this?

Weiss: Right now, there is an increasing number of audits coming from multiple contractors and payers across the country. Keeping audit activity organized and tracked deserves more time and attention than ever before. This session will discuss how to manage and prepare for audits, as well as how to react when you receive audit notifications.

Q: What’s one of the key pieces of information you would like people to take away from your session?

Weiss: Managing audits doesn’t have to be complicated, nor does it require a lot of sophisticated technology or software.

Q: What are you most excited about for this year’s topic? Or, what are you most excited about for this year’s conference?

Brown: The networking and collaborative opportunities, which offer such a valuable experience! Engaging with others who have similar roles and responsibilities always sparks new ideas and solutions to everyday issues that we may not think of in our daily workflows.

Q: What's a great piece of advice you've received regarding revenue integrity? Or, what advice do you like to give people about revenue integrity?

Brown: The revenue integrity field, which offers several variations in responsibilities, is an area of healthcare that allows us to really make a difference for our hospitals, providers, and patients. We know that the work we do supports solid documentation and proper reimbursement for the care that our patients receive.