Over the past few years, physician practices have struggled to respond to the increased use of medical audits by federal, state and private health care payers seeking reimbursement of payments often erroneously attributed to inappropriate billing. These audits are disruptive to physician practices and often cause substantial financial hardship as many payers delay or cease payments to the audited practice until audits are complete or recoup alleged overpayments before any ruling on appeal.

Physicians need to consider medical audits as a routine part of their businesses and plan accordingly. There are many actions that physicians can take to mitigate the risk of being audited and the potential for adverse audit findings in the event of an audit.

To educate and arm physicians with information and tools relating to medical audits, the Physicians Advocacy Institute (PAI) and the American College of Emergency Physicians (ACEP) have joined together to develop a toolkit for physicians facing medical audits.

The toolkit is designed to provide physicians with practical resources and information to help assess if their practice is a likely candidate for an audit, mitigate the possibility of an audit, provide tools to help respond to an audit request and, where necessary, assist in appealing audit findings.

It includes several practical resources: Medical Audits: Top Ten Tips for
Physicians to Anticipate, Respond and Protect Their Practices, Physician Checklists for
Submission of Medical Records in Response to an Audit Request and for Appealing Audit Findings, and articles with detailed information about medical audits. In addition, PAI and ACEP intend to offer a series of Webinars with practical information for physicians facing medical audits.

Click here to access the toolkit on PAI’s website.

Categories: Communications, ASAP, Practice Management, Coding and Billing