You’ve Got This Now
Payers audit hospital accounts to reduce or recapture reimbursements, but those audits are not always valid. If you are experiencing a shortage of staff, qualified knowledge to appeal or documentation to defend these audits, Knowtion Health can help. We protect reimbursements by overturning audit findings and reduce future audits by providing expert insights on documentation and process improvements.
Our audit defense program can help you protect your interests. Knowtion Health can have you saying: You’ve got this now.
Our experienced audit team will be your tactical and technical advantage. With over 15 years’ experience on both the provider and payer sides, we provide nurses (RNs, LPNs and RNs who are certified coders) who defend reimbursements through persuasive, medically supported arguments that draw from InterQual, MCG (formerly Milliman), coding, billing and payer guidelines.
Our team also consists of attorneys who are experienced in complex payer demands and creating reasoned arguments and coders who are certified and current with all coding.
Knowtion Health can ensure you there are no more missed audit documentation request deadlines. Our analysis and feedback can help you make coding and document improvements to reduce future audits and ensure proper payment.
We also incorporate Medicare Guideline Compliance, CDI education and recommendations, insights into business process reengineering and guidance for continuous process improvements. Even when we agree with audit findings, we provide clear analysis and training to help reduce future audits.
By triaging your accounts to the right team who have years of experience defending reimbursements through persuasive and medically supported arguments, we’ll maximize your net recoveries from payment variance and recoupments.
We can further reduce future underpayments and recoupments by reporting on identified payer trends and attending payer discussions and meetings.
We provide CDI recommendations as well as complimentary staff education and workshops tailored to your accounts and payers to help you improve processes and reduce the likelihood of audits.
Knowtion Health’s audit defense services will triage every account. For appeals, our team will research and write “conscious” appeals (i.e. readmission, DRG Downgrades, Charge Outlier audits) rebutting payers' dispute rationale -- not just defending based on a general argument or from a medical necessity perspective. When we agree with findings, we will provide clear analysis, feedback and training to help staff reduce future audits.
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