How many bites at the apple are audit companies allowed?
I appealed a cross claim denial by Cotiviti back in the beginning of April I just got it back and now they agreed with my appeal, but have come to a new determination to try and change the PDX and down grade the DRG again. How many bites at the apple do they get? This seems to place an undue financial burden on the hospitals/providers. Had they actually looked at the medical record before the first denial they would have seen the original denial was not valid and maybe sent this one. This just doesn't seem right! First, cross claim reviews done by Cotiviti sending denials based on comparing professional billing history with the inpatient bill and denying anything that is not in the patient's history is disgusting we received upwards of 90 at one time had to appeal each one and send medical records with each one because they had not requested medical records yet. They were mailed and by the time they reached us we had maybe a 10 day or less turn around time. So of course we had to fed ex the records because their portal to upload medical records would not work. More cost to our institution. Now 4 months later results are trickling in and they agreed with my appeal and are taking a second bite at the apple? Has anyone dealt with this? Do we have any recourse? 😒