Trends We’re Seeing at End of First Quarter: Denials and Audits Increasing

With the first quarter of 2021 just finished, the Paramount Health Solutions (PHS) team is sharing some of the major trends we’re seeing:

  • Full force of denials from government and commercial payers.

“OIG, CMS and many commercial insurance companies showed leniency last year when the pandemic was first unfolding,” said Bilal Mushtaq, M.D., COO of Paramount. “We’re now seeing denials back to the levels that were occurring in 2019, pre-pandemic.”

  • OIG audits are increasing.

“Suspensions were put in place regarding investigations to allow hospitals to focus on COVID-19 surges,” Mushtaq said. “Recently, several of our client hospitals have had OIG audits and we have helped them to respond. Many hospitals will be targeted this year.”

Mushtaq warned that if a hospital doesn’t have a full-blown internal DRG or clinical validation program, they are especially vulnerable to audits and may also receive penalties to return money that was deemed improperly billed.

Smaller more rural hospitals and public hospitals typically have a more difficult time recruiting and retaining experienced, credentialed CDI/DRGV employees. Paramount Health Solutions fills this need by performing these crucial services and providing oversight to help prevent and catch errors and omissions in clinical documentation and coding.

To start a conversation with Paramount Health Solutions, simply fill out this form, or call (615) 347-4867 or (210) 725-3444.