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Payment Integrity Audits Proves to be a Burden for Clinicians

A study conducted by Change Healthcare highlighted a serious matter about the payment integrity audits. It stated that payment audits cost physicians up to $1 million for administrative expenses each year.

Clinicians who consult a third party for medical billing services have lesser data to handle in general. However, the effect remains the same. Not just clinicians have to compile claims and send them to the payers, but the additional auditing load adds to the pressure. Moreover, it also dents the relationship between both physicians and insurance companies, government or private.

So, What Is the Solution?

A pre-submission notification process for claims seems a suitable solution. Medical billing companies can be of great help in this regard. They can stay in touch with the payers to know the potential errors before the claim submission. It certainly improves the accuracy of claims and reduces potential errors.

Moreover, the risk of post-payment integrity audit is also reduced.

Technology Can Help Win This Game

Technology is a savior when it comes to assisting in operations. To reduce the burden of data administration, medical practices and medical billing experts can use technology. Moreover, a significant amount of time is also reduced.

Physicians say that it is a huge step in minimizing the risk of post-payment integrity audits. We can also see a reduction in associated costs.

Why Post Payment Audit Is An Issue?

Many payers fail to understand that why post-payment integrity audit is an issue with physicians when it helps with financial stability.

However, the truth is ensuring payment accuracy is costly. A regular audit by the payers or medical billing company applies to the utilization of codes, accuracy of bills, quality of healthcare, and the incurred costs and efforts.

What is concerning that up to four out of ten providers do not know that post-payment auditing is costing their medical practice.  Moreover, it is not just about the administrative load and cost, but many physicians have negative experiences with these programs.

Most requests for the audits concern the correct billing of clinical procedures. However, the majority of cases end up in dissatisfaction.


A better strategy for clinicians or their hired medical billing companies is to pay more attention to the pre-claim submission process. With lesser chances to mess up, the need for post-payment integrity audits will reduce.

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