Interesting thought...this would be a good job for someone who likes audit work and wants a business of their own. wonder if there is demand out there/need? In my parts, insurance companies and hospitals now employ their 'own' auditors and they are wearing multiple hats I think...are in UR and CM depts, etc.
I used to do bill audits as an independent contractor, third party through a contracting agent. The actual audit was interesting, I learned a lot. The resolution was the challenge.
Insurers withheld a portion of the bill pending audit and of course the hospitals wanted their $$$, so they both want the auditor to resolve the situation immediately and in THEIR favor...LOL!
Hospitals in my parts hired their own suditors to peruse the chart and ADD charges...often based on vague nurses notes entries without corroborating billing.If it was legit I would go along with it out of honesty, but often it was not viable legally. I got tired of arguing with hospital auditors to be honest.
I learned a lot and caught a lot of mistakes...like charging $400 for an IVPB vs the actual $40 it should be...over 2 weeks of therapy that was a chunk of change. Also stuff like recovery room charges charged to the wrong patient's bill, (never had a surgical procedure). Sometimes I also found the opposite...like the hospital charged for a recovery room fee only because the surgical room charged never made it....
I ran into a lot of other nurse auditors who worked directly for the insurance company and were under more pressure to perform than I. My third party company is not longer here or I might consider returning to auditing at this point in my life.
If one enjoys negotiating/haggling and can't do bedside nursing, it might be a good fit for an older nurse or someone who wants away from clinical nursing.
Good luck to you...hopefully you will hear from nurses more up to speed with what's going on in this area! Good thread!!
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Any RNs doing Hospital Billing Audits?
Re: Any RNs doing Hospital Billing Audits?
