Maintaining your provider network: Tips for keeping docs despite an audit

As a Medicaid agency, you’re tasked with maintaining a provider network of sufficient size, quality, geographic range and breadth of services to meet the needs of your state’s most vulnerable population. But maintaining positive, productive provider relations during a recovery audit can be challenging.

One thing you can do is build up a store of goodwill before you send out your first letter. One way to do that is to concentrate not just on overpayments, but on underpayments as well. While audits are generally associated with wrongdoing and the unpleasant consequences of that wrongdoing, audits can just as easily indicate errors resulting in underpayment, such as miscoding. Who wouldn’t feel good about that?

Although you can’t deliberately give each of your providers some “good” news in the hope of tempering any “bad” news in the future, having a reputation for pursuing underpayments as well as overpayments, or at least being able to point out the sum of reimbursements, can do a lot to build trust and an overall sense of fairness.

For more tips on how you can prevent or reverse provider abrasion, read “Reducing provider abrasion during a recovery audit.”

— Lane Edenburn and Brian Fisher

About the authors

Lane Edenburn



Lane Edenburn is vice president, government program integrity solutions, at Optum.




Brian Fisher is integrity account manager, Iowa Medicaid program, at Optum.

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