Final answer:
The hospital's first action in response to a payer's audit for a suspected payment error should be to organize and review all relevant records from 2010, convene a team involved in the billing process, and conduct an internal review to identify any potential errors before the auditors' review.
Step-by-step explanation:
When a hospital is notified by a payer that it is conducting an audit due to a suspected payment error from a past year, the hospital's first action should be to organize and review all relevant records from the year in question. Prompt and organized response is essential.
Similar to Noel's situation where a prompt and attentive reaction to a billing error saved the organization $250,000, the hospital must be diligent about addressing the audit notification.
First, gather the team involved in billing and payment processing, including accounting and management staff, to ensure that everyone is aware of the audit. Next, begin compiling all documentation and information related to the transactions that are being audited.
This includes patient records, billing statements, payment receipts, and any correspondence with the payer.
Once the records are organized, the team should conduct an internal review to identify any discrepancies or potential errors. It is also crucial to understand the specifics of the suspected error mentioned by the payer.
Then, cooperate fully with the audit process, providing the requested documentation in a timely and efficient manner to the auditors. If errors are found, be prepared to discuss them, take corrective measures, or provide an explanation.