Successfully managing audits and avoiding compliance pitfalls
Editor’s note: Amy Inch, CPC, CPMA, COTA, will present “Navigating the Current Audit Landscape” on day one of the 2025 Revenue Integrity Symposium (RIS), which will take place September 25–26 in Westminster, Colorado. Inch is a Medicare regulatory specialist with HCPro in Chicago, Illinois. Get an exclusive insider’s look at what RIS attendees will learn and experience at the event, discuss highlights from the agenda, and more during our upcoming free webinar! Use NAHRI’s justification letter template as a guide to gain your organization’s support for attending. Consider applying for the NAHRI Scholarship, which awards free registration to RIS (the application deadline is June 6).
Q: In what ways does your session challenge attendees to think outside the box?
Inch: The results of audits and investigations often contain valuable information related to enforcement of billing and payment regulations, requirements and expectations in audits and investigations, and supportive documentation to use in appeals. This session uses case studies to demonstrate the benefits of turning to these resources to assist in internal audits, documentation requests, and appeal development.
Q: What’s the biggest challenge in revenue integrity and/or revenue cycle right now? How does your session help tackle this?
Inch: One of the challenges in revenue cycle/integrity is compliance with coding, billing, and coverage regulations. This session provides insight into current audit focus of CMS and the Office of Inspector General (OIG), with emphasis on identifying findings and recommendations that can be incorporated into compliance strategies.
Q: What’s one of the key pieces of information you would like people to take away from your session?
Inch: That CMS and the OIG want the medical community to be successful at providing necessary care with accurate reimbursement. They provide many resources to assist in achieving that success.
Q: What are you most excited about for this year’s conference?
Inch: I am excited to learn more about revenue cycle and revenue integrity from so many knowledgeable speakers and attendees. RIS brings together different perspectives to provide insight and direction on a variety of topics.
Q: What's a great piece of advice you've received regarding revenue integrity and/or revenue cycle? Or, what advice do you like to give people about revenue integrity and/or revenue cycle?
Inch: The auditor’s job is to find the truth of what was performed by the medical provider/practitioner. The auditor may have a piece of the puzzle that indicates claims may be incorrect. This is the reason they request additional information, to obtain a more complete picture of the service that was performed in order to more accurately determine appropriate payment.