The Physicians Advocacy Institute (PAI) has collaborated with the American College of Emergency Physicians (ACEP) to develop a Toolkit for Physicians Facing Medical Audits.  The Toolkit provides practical information and tips to guide physicians in anticipating medical audits, responding to auditors’ requests for medical records, and appealing erroneous audit findings. The Toolkit also includes detailed information regarding the various types of governmental and private payer audits, appellate procedures, and extrapolation methodologies used by some payers to calculate alleged overpayments.

The Toolkit includes the following resources:

• Medical Audits: Top Ten Tips for Physicians to Anticipate, Respond and Protect Their Practices (PDF)
• Tips for Physicians Facing Private Payer and Governmental Audits (PowerPoint - updated March 18, 2015)
• Checklist for Physicians Responding to Requests for Medical Records (PDF)
• Checklist for Physicians Appealing Audit Findings (PDF)
• PAI’s White Paper:  Medical Audits:  What Physicians Need to Know (updated - PDF)
• ACEP’s Preparing for Physician Audits (PDF)
• Article:  The Significance and Implications of the Delay in the Assignment of ALJs in Medicare Part B Appeals (PDF)

We urge medical associations to share these resources with physicians.  For that purpose, we have developed a template for “co-branding” the toolkit.  For information on how your organization can include information and a link to the Toolkit via a website and/or newsletter, please refer to the following documents: 

• PAI-ACEP Medical Audit Toolkit Guidelines (PDF)
• Sample News Release (PDF)
• Sample Newsletter article (PDF)
• Cover page for organizations seeking to “co-brand” Toolkit (Word document)

PAI/ACEP Webinar:  "Medical Audits & Tips for Physicians Facing Private Payer & Governmental Audits" - April 10, 2015  (mp4 file; 56 minutes in length)  Please note: the file is large and may take a moment to begin.

Additional Audit Resources

•  Fair Medical Audit Principles (PDF)