Which objective aligns with identifying post-payment risk?

Which objective aligns with identifying post-payment risk?

• A. Auditing current patient intake procedures.
• B. Verifying the accuracy of ICD-10 codes for a single claim.
• C. Identifying and assessing potential post-payment risk.
• D. Reviewing payer marketing strategies.

Answer: (C)

Post-payment risk refers to issues that can occur after a claim has been paid, such as overpayments, improper payments, duplicate payments, or fraudulent activity that slips through initial checks. The objective that best aligns with identifying these risks is the one that explicitly aims to identify and assess potential post-payment risk. This involves looking back at paid claims, conducting retrospective audits, and analyzing payment patterns to flag and evaluate areas where incorrect payments might have occurred, so controls can be put in place and improper payments recovered if needed. Auditing current patient intake procedures targets the pre-payment stage, aiming to prevent errors before claims are processed. Verifying the accuracy of ICD-10 codes for a single claim focuses on coding accuracy for a specific submission rather than assessing risks that arise after payment. Reviewing payer marketing strategies relates to business development and is not about payment risk.

Post-payment risk refers to issues that can occur after a claim has been paid, such as overpayments, improper payments, duplicate payments, or fraudulent activity that slips through initial checks. The objective that best aligns with identifying these risks is the one that explicitly aims to identify and assess potential post-payment risk. This involves looking back at paid claims, conducting retrospective audits, and analyzing payment patterns to flag and evaluate areas where incorrect payments might have occurred, so controls can be put in place and improper payments recovered if needed.

Auditing current patient intake procedures targets the pre-payment stage, aiming to prevent errors before claims are processed. Verifying the accuracy of ICD-10 codes for a single claim focuses on coding accuracy for a specific submission rather than assessing risks that arise after payment. Reviewing payer marketing strategies relates to business development and is not about payment risk.