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How to improve payer-provider relationships during audits.

Dawn Crump, Jeannie Hennum

    Healthcare Financial Management : Journal of the Healthcare Financial Management Association
    |December 16, 2015
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    Summary

    Rising medical record audit requests worsen payer-provider communication. Educating both parties on audit reasons and required information can improve processes and reduce friction.

    Area of Science:

    • Healthcare Administration
    • Medical Auditing
    • Payer-Provider Relations

    Background:

    • Increasing volume of medical record audit requests presents significant challenges.
    • Communication gaps between payers and healthcare providers complicate the audit process.

    Purpose of the Study:

    • To highlight the communication issues arising from increased medical record audits.
    • To propose solutions for improving payer-provider interactions during audits.

    Main Methods:

    • Analysis of current trends in medical record audit requests.
    • Review of communication challenges in the audit process.

    Main Results:

    • Audit request volume is increasing, straining payer-provider communication.

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  • Lack of clarity on audit reasons and required information causes friction.

    • Conclusions:

    • Enhanced understanding of audit purposes and information needs is crucial for both payers and providers.
    • Educational initiatives can improve audit processes and mitigate payer-provider friction.