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Tag Archives: auditor

Outside independent auditor

Hi one our our specialty providers is looking for an outside independent auditor to go over his coding to ensure he is coding correctly. His specialty is Craniofacial plastic surgery and also works very closely with several Neurosurgeons. Because of this specialty, the coding can be very tricky and he wants to ensure that he is coding the difficult procedures correctly. If anyone has a name of an independent auditor, I would appreciate the info to get in touch with this person to do a private audit.

Thank you,

Marybeth Connolly, CPC
Physicians Management, Inc.
Billing Manager

Medical Billing and Coding Forum – Plastic Surgery

What do you do when the auditor just will not respond?

I work at a Substance Abuse Rehab and Cigna has been doing audits of all of their out of network providers. I have not heard of a single facility that has passed the audit. We recently had our audit completed and predictably failed (even though a retrospective audit from Optum BH came up with 0 problems during the same time span). We now have a no payment flag placed on our facility and we are forced to refer patients that come in with Cigna to other facilities.

I have been trying to contact our auditor since the day we found out the flag was placed on our facility. She sent me one email that was very terse and stated a letter would be sent out later that week……that was 6 weeks ago and we have yet to receive the letter. Since then I have called and or emailed 2 or 3 times per week and I have gotten nothing. I have no idea why we even failed the audit and at this point all we are doing is turning patients away.

Personally I believe ignoring me is purposeful on the auditors part. I also believe that the audit itself is punitive and is meant to drive out of network providers away from accepting Cigna patients rather than to improve care for their patients. Basically, the longer the auditor ignores me, the longer any appeal process will take. I am wondering if I have any legal recourse in this matter. If the auditor will not respond to me, who do I talk to? Almost all of Cignas plans are self funded, so they are under ERISA, which I believe rules out state insurance commissioners. I am completely lost here and any direction will help a great deal.

Medical Billing and Coding Forum – Payer/Health Plan