Even after hospitals have been paid, they still face the threat of post-payment audits, which can result in retractions if the payer looks back and deems that the information submitted does not support the claim. In this scenario, the hospital must either accept the audit findings and refund the money, or challenge the findings through the appeals process.
At HLS, we have represented numerous clients that have been targeted by unfair audits and refund requests by appealing on their behalf. We have succeeded in getting the payer to reinstate the original payment amount in full by showing that the hospital’s billed charges appropriately reflect the services it provided.
To learn more about how HLS can defend a hospital against a payer or third-party audit, click here to read some of our case studies