Audits: Appeal early, appeal often

A. Many suppliers consider waiting until the end of the timeline for appealing a claim so they can group together as many claims for that patient as possible, viewing this as a savings in manpower and employee expense.  While writing only one appeal may be a savings in one part of your workload, putting off getting a favorable appeal decision costs much more than it saves.

Suppliers often call me with similar stories.They received an audit for January's rental claim, February and March claims were paid, and now claims from April onward are being denied. The reason for the on-going denials is because of the original audit denial. The only way to stop the denial from rolling in is to overturn the audit finding. The quicker you get a favorable appeal decision, the quicker you can obtain a payable status on the rental claims and end the denial/appeal cycle. Waiting to appeal the original audit only prolongs the process, costing you more money in the end.

Another benefit in this case is the ability to use the reopening process. Once you obtain a favorable decision on the audited claim, you can reopen (instead of appealing to redetermination) any later rental claims that were automatically denied without individual audit.  The reopening process is easier and quicker than a redetermination appeal—meaning less employee time and better cash flow.

The number one goal in a ZPIC audit is to decrease the error rate. By allowing denials to stack until the end of the filing period, you are prolonging the actual ZPIC audit. The best—and quickest—way to get off a ZPIC pre-payment audit is by having a low error rate. For ZPIC audits there should only be one approach to appeals: appeal early and appeal often!

Jillian Longo is a consultant with Harrington Management Group, LLC. Reach her at jlongo@theauditteam.com or 888-833-3478.