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Denials and payments

Preparing for payer audits and recoupments

Audits are easier when your records already tell the story.

What auditors look at

  • Anesthesia start and stop times, and whether they're supported
  • Modifiers against how cases were actually staffed
  • Medical direction documentation
  • Diagnosis codes that support medical necessity

Habits that protect you

  • Complete anesthesia records for every case
  • Regular internal audits of a sample of claims
  • Fix and refund overpayments you find yourself, promptly

When an audit letter arrives

Note the deadline, gather exactly the records requested, and get advice early if the amounts are large. A healthcare lawyer can help you respond.

This article is general information, not billing, legal or tax advice. Payer rules change; always check current guidance.

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