Episode 12: Overpayment: Managing medical records requests and avoiding payor audits

April 24, 2018

Podcast

Cleveland attorney Elizabeth Sullivan, co-chair of the firm’s national Healthcare Practice Group, sits down with host Mike Witzke to discuss why payor audits must be taken seriously and how healthcare providers should respond to medical records requests to avoid overpayment claims. Sullivan also explains why it is important for providers to be proactive and not reactive regarding payor audits.

Over the past 24 months, the U.S. Department of Health and Human Services Office for Civil Rights has brought notable enforcement efforts against several non-profit covered entities and business associates, resulting in instances of six and seven-figure penalties against providers across the county for incidents involving breaches of protected health information.

A new amendment to New York state law, which would have required all healthcare providers to obtain separate consents from patients for treatment and payment is on hold until further guidance is released, according to the New York Department of Health.

On November 1, 2024, the Centers for Medicare & Medicaid Services issued the Medicare Physician Fee Schedule 2025 final rule, which establishes new advanced primary care management billing codes that will expand opportunities for physician practices, federally qualified health centers, rural health clinics and other health care providers to get paid for services provided by clinical staff under the direction of a physician, nurse practitioner or physician assistant beginning January 1, 2025.

Episode 12: Overpayment: Managing medical records requests and avoiding payor audits

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