tci Medicare Compliance & Reimbursement - 2023 Issue Q1
Audits: Use This Advice to Better Explain Audit Results to Providers
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Article Overview
This article covers best practices for discussing audit results with providers after an internal or external review. It is aimed at auditors, coders, compliance staff, and practice leaders who need guidance on preparing for difficult conversations, handling disagreement, and presenting findings in a constructive way. The discussion focuses on communication approach, meeting preparation, confidentiality, backup support, and using audit feedback as an educational tool.
Why This Topic Matters
Audit results can affect provider relationships, compliance discussions, and follow-up actions. Understanding how to present findings clearly and respectfully helps organizations reduce conflict and turn audit reviews into opportunities for improvement.
Article Sections
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Find Out These 3 Things First
This section covers key planning questions to answer before discussing audit results. It addresses readiness, organizational decision-making, and whether findings are presented to an individual or a group.
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Prepare for Potential Trouble Via Backups
This section discusses steps to take when a conversation may become difficult. It focuses on support, escalation planning, and ways to handle uncomfortable audit discussions.
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Bring Your Homework With You
This section reviews preparation resources and ways to keep the discussion grounded. It emphasizes having reference materials available, responding to questions appropriately, and framing findings as opportunities for education and improvement.
What You Will Learn
- How to prepare for provider conversations about audit results
- How to account for organizational policies and group-versus-individual reporting
- How to manage difficult reactions during audit feedback meetings
- How to use reference materials and follow-up planning during audit discussions
- How to present audit findings as educational and improvement-focused
Who Should Read This
- Medical coders
- Auditors
- Compliance staff
- Practice managers
- Physician office administrators
- Healthcare educators
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