Clinical Validation Audits and the Impact on Hospitals and Health Systems

Clinical validation audits are a new tactic that certain commercial insurers are adopting to reduce or deny payment to health care providers. These audits can take months or even years to be adjudicated and resolved. In this conversation, Richelle Marting, director of managed care contracting at North Kansas City Hospital, and Chris Thompson, executive director of reimbursement and compliance for managed care at AdventHealth, discuss the rapid growth in these audits, the financial strain they can put on hospitals and health systems, and what can be done to protect providers.