Fair Medical Audits

WORKING TOWARD A FAIR AUDIT PROCESS

Physician Audits

PAI has long identified problems associated with medical audits as among the major challenges facing physicians today and has championed the cause for greater transparency and a fairer audit process. PAI has developed a multifaceted advocacy plan designed to address problems faced by physicians in preparing for and responding to medical audits, which include:

  • Lack of transparency in the audit process
  • Unqualified auditors
  • Inaccurate audits, often due to flawed extrapolation formulas
  • Recoupment of alleged overpayments before conclusion of the appeal process
  • Contingency payments to RAC auditors
  • Excessive look-back periods
  • Punitive rather than educational focus of many payers and auditors

For more information on PAI efforts in this area, contact Kelly Kenney, PAI Counsel at k2strategiesllc@gmail.com.

GOVERNMENT ADVOCACY

The has worked for several years to secure fairer practices within the RAC audit program and currently endorses the Fair Medical Audits Act of 2015, which was introduced by U.S. Representative George Holding (R-NC).  Learn more about our latest advocacy efforts.

Tools for Physicians

Another critical aspect of the PAI’s work has been to better educate physicians on how to prepare for and defend against a medical audit. The PAI partnered with the American College of Emergency Physicians (ACEP) to develop a comprehensive physician toolkit on medical audits.  View toolkits and other PAI resources for physicians.

IMPACT OF AUDITS

To highlight the real life impact of certain audit practices, PAI President and EVP/CEO of the North Carolina Medical Society Robert W. Seligson produced a video, “Guilty until Proven Innocent: When Medicare Audits Cause Casualties,” depicting how an unfair Medicare audit devastated one North Carolina medical practice.