Welcome to Innovations in Oncology ManagementTM, a newsletter series for oncology practice administrators, administrative staff, advanced practice clinicians, and oncology pharmacists. The series provides concise, up-to-date information on current issues that are impacting the business of oncology. Our first newsletter in this second series focuses on navigating Medicare, Medicaid, and commercial payer audits.
Government and commercial payer audits have increased significantly in recent years in an effort to identify and prevent overpayments and reduce waste in the healthcare system. Over the past 5 years, Medicare’s audit program has recouped more than $8 billion in wasteful and fraudulent payments. Encouraged by the success of government audit programs, commercial payers have followed suit and developed auditing programs as well. The article featured in this issue––Navigating Payer Audits––discusses the current landscape of payer audits and provides practical tips for practices that are facing a potential audit. In a special interview, Patricia Krueger, RPh, a practice administrator, shares her practice’s experience with government and commercial audits, and provides advice on traversing the payer audit process.
We hope you enjoy this newsletter and find it to be a valuable resource for your practice. Previous newsletters have explored a variety of topics and can be found by visiting www.innovationsinoncologymanagement.com.