decisionhealth Newsletters, Part B News - 2016 Issue 10 (October)
The Stark Reality: Costly mistakes with collections, contract review, communication
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Article Overview
This article summarizes revenue audit findings from Stark Medical Auditing and Consulting and focuses on operational issues that can affect medical practice collections and reimbursement. It is aimed at practice managers, billing leaders, auditors, and physician groups that work with collection agencies, commercial carriers, and hospital administration. The piece covers three audit scenarios and the associated management recommendations for improving oversight, documentation review, and communication workflows.
Why This Topic Matters
The article highlights how routine administrative breakdowns can lead to significant revenue loss, denials, and avoidable conflict. It is relevant to organizations trying to strengthen billing operations, contract oversight, and interdepartmental communication.
Article Sections
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Revenue audit findings
An overview of the audit series and the operational themes covered in the article.
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Audit No. 1: Collection agency errs, risks $565K
A collection oversight scenario involving reporting discrepancies, account tracking, and follow-up review processes.
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Recommendations
General management suggestions related to collection oversight and protecting revenue from worked accounts.
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Audit No. 2: Intense review of new contracts
A contract management scenario involving payer agreements and revenue disruption after a new contract is signed.
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Recommendations
General guidance on contract review and monitoring payment patterns after agreement changes.
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Audit No. 3: Problems from poor communication
A communication breakdown scenario involving billing transitions, hospital administration, and patient statement concerns.
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Recommendations
General guidance on communication planning and coordination during billing transitions.
What You Will Learn
- How audit findings can reveal collection process problems
- Why contract review matters when payer agreements change
- How communication gaps can affect billing operations and patient outreach
- Common management themes in revenue audits for physician practices and hospitals
Who Should Read This
- Practice managers
- Billing managers
- Revenue cycle professionals
- Medical auditors
- Physician group administrators
- Hospital-based practice leaders
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