Study shows payer audits a financial burden for providers

February 5, 2020

A recent study revealed that payment integrity audits by payers can cost providers as much as $1 million in administrative costs a year.

Payers or their third-party vendors routinely audit claims related to a hospital stay to ensure providers applied appropriate care, utilization, and billing codes to claims. But 8% of providers are spending upwards of $1 million dealing with post-payment audits each year, according to the report.

Another 10% spend between $500,000 and $1 million, and 46% spend $500,000 or less annually. Four out of 10 providers said they have no idea what the audit process is costing their organizations.

The report, “Payment Integrity Programs: A National Study on the Impact of DRG Audits on Provider Sentiment and Abrasion” was conducted by Frost & Sullivan and commissioned by Change Healthcare.

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