decisionhealth Newsletters, Part B News - 2012 Issue 2 (February)
5 strategies to avoid, deal with a billing investigation by a special investigations unit
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Article Overview
This article discusses general compliance practices for providers who may face a private payer special investigations unit investigation. It explains why these investigations matter, who should read the guidance, and the broad prevention and response themes covered, including staff vetting, payer policy review, documentation readiness, and legal support.
Why This Topic Matters
Private payer SIU investigations can have significant consequences, so providers, billers, and compliance teams benefit from understanding how to reduce risk and respond appropriately at a high level.
Article Sections
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Compliance
Introduces the article’s compliance focus and frames the topic around preparation for payer investigations.
What You Will Learn
- How the article frames private payer SIU investigations and related compliance risk
- General preventive practices for billing and staff oversight
- Why payer policy review and legal support are emphasized in this context
- Broad considerations for responding to discrepancies during an investigation
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Practice managers
- Healthcare attorneys
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