Provider Enrollment, Billing, and Payment Audits

Ott Cone & Redpath works with healthcare providers, from large academic medical centers to individual specialized providers, to address provider enrollment, billing, and payment audit issues.

Provider Enrollment, Billing, Compliance, and Contracts

We understand the complexities medical providers face in dealing with provider enrollment, billing, and payment contracts. We are experienced in helping medical providers of all sizes and specialties address the following issues:

  • Billing Compliance
  • Managed Care Contracts
  • Prior Approval and Medical Necessity Reviews
  • Provider Enrollment, Exclusions, and Credentialing

Payment Audits

We help our clients avoid audits by advising and assisting in establishing appropriate documentation and billing procedures. Our ongoing education helps keep our clients in front of the issues raised in audits and provides a way to help proactively address issues to prevent recoupments. Ott Cone & Redpath’s unique knowledge of regulatory requirements, clinical coverage policies and payment methodologies allows effective and timely results.

Whether the audit is being performed by the Centers for Medicare and Medicaid Services (CMS), the state Medicaid agency, an audit contractor, or some other entity, we provide resolute advocacy for our clients, who rely on our experienced professionals to represent them in settlement negotiations, administrative proceedings, and judicial review.

We assist hospitals, independent practitioners, and mental health providers with various types of governmental and insurance audits, including:

  • Medicare Billing and Payment Audits
  • Medicare and Medicaid Recovery Audit Contractors (RAC) Audits
  • Medicare and Medicaid Disproportionate Share Hospital (DSH) Audits
  • Medicaid Integrity Contractor (MIC) Audits
  • Medicare and Medicaid Electronic Health Record (EHR) Incentive Meaningful Use Audits
  • Pre- and post-payment Reviews
  • Insurance Company Audits
  • TRICARE Audits