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Understanding Payer Audits With David Vaughn JD, CPC

The Private Medical Practice Academy

Understanding Payer Audits With David Vaughn JD, CPC

July 12, 2022

Understanding Payer Audits With David Vaughn JD, CPC

Are you afraid of getting audited by insurance companies or Medicare? Do you get anxious when one of the payers sends you a request to audit 5 of your charts?  Have you heard horror stories of the Feds knocking on a physician's door? Don't worry–you are not alone. 

But not all audits are created equal.

Today David Vaughn joins me to discuss what you need to know about the different types of payer audits. David is both an attorney and certified professional coder and has been my healthcare attorney for 20+ years. David has been instrumental in helping my practice's billing compliance.

Here are some of the topics we discussed during our conversation:

  •  the difference between a benign audit and the one you should be worried about
  • what to do if you get audited
  • what your liability is with regard to coding
  • the importance of self-audit
  • how denials may give you insight into your audit risk
  • the difference between federal payers and private payers
  • in-network vs. out-of-network audit risks

If you are in private practice you will not want to miss this episode!

More about David Vaughn: David is one of a limited number of healthcare attorneys in the United States who is also a Certified Professional Coder®, certified by the American Academy of Professional Coders® (“AAPC®”).

David has served on the Legal Advisory Board of the AAPC and has written several coding and compliance books and manuals. He is also a national speaker on the legal implications of billing and coding. He also has a national healthcare law practice, and has represented over 2,000 physicians in approximately 40 states in over 10 physician disciplines. His practice consists of representing providers in federal and state prosecutions, qui tam cases, and Medicare and third-party payer audits. He also conducts audits and provides education to providers.

You can reach David at [email protected]

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