Louisiana Administrative Code
Title 37 - INSURANCE Part
Part XIII - Regulations
Chapter 25 - Regulation 49-Billing Audit Guidelines
Section XIII-2519 - Fees and Payments

Universal Citation: LA Admin Code XIII-2519

Current through Register Vol. 50, No. 9, September 20, 2024

A. Payment of a bill shall be made promptly and shall not be delayed by an audit process. Payment on a submitted bill from a third party payer shall be based on amounts billed and covered by the patient's benefit plan.

B. Billing audits shall be made in accordance with one of the following three audit fee and payment schedules:

1. a $100 audit fee shall be paid by the auditor to the audited party. Such audited party shall not require payment greater than 100 percent of the audited party's submitted bill minus such party's historic error rate;

2. in those instances where the audited party has had less than 12 audits in a calendar year, the error rate shall be set by mutual agreement between the audited party and the qualified billing auditor; and when the parties cannot agree, then the historic error rate shall be presumed to be 7 percent; and

3. the $100 fee shall be waived in the following scenarios:
a. payment of 100 percent of the covered benefit plan has been made; or

b. the on site audit commencement date exceeds 60 days from the date of the request for audit; or

c. audit fees are not required or are otherwise being waived.

C. Each provider's billing audit coordinator shall maintain a log containing the results of all audits performed by external qualified billing auditors in the preceding 24 months. In cases where the log is not complete for the past 24 months, the error rate shall be set by mutual agreement between the audited party and the qualified billing auditor; and when the parties cannot agree, then the historic error rate shall be presumed to be seven percent.

D. The audit log shall contain the amount billed immediately preceding the audit, and net adjustment resulting from the audit, the name, address, and phone number of the audit firm conducting the audit, and the name of the qualified billing auditor who performed the audit. Audits whose results are in dispute and audits ordered by the provider and conducted by its own or contracted audit organization shall not be included in the audit log. The audit log shall be available at all times during regular business hours for inspection by any qualified billing auditor.

E. Audit fees, if needed, are to be paid upon commencement of the on site billing audit. Any payment identified in the audit results that is owed to either party by the other shall be settled by the audit parties within a reasonable period of time-not to exceed 30 days after completion of the audit unless the two parties agree otherwise.

F. Neither the provider nor the qualified billing auditor shall require a billing, or re-billing, or refund request following final audit determination, but all findings shall be netted, and the final result will be due by the relevant party without additional billing.

G. Photocopying and duplication charges shall be paid in accordance with R.S. 40:1299.96.

AUTHORITY NOTE: Promulgated in accordance with Act 664 of the 1993 Regular Legislative Session and R.S. 22:12.

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