2024 Gastroenterology Reimbursement and Coding Update | November 2023-09 - Auditing Physicians and APPs in Your Practice

Pdf Summary

The document discusses auditing physicians and advanced practice providers in a medical practice. The presenter emphasizes the importance of educating providers on coding and billing issues and not assuming that they have extensive knowledge in this area. Benchmarking for Evaluation & Management (E&M) codes specific to gastroenterology is mentioned as a way to minimize the risk of an audit. Different types of audits are also highlighted, including those carried out by the Office of Inspector General (OIG), Recovery Audit Contractors (RACs), Certified Error Rate Testing (CERT), and Zone Program Integrity Contractors (ZPICs).<br /><br />The presenter suggests that providers should respond seriously to any audit requests, regardless of whether they are routine or involve suspected fraud or false billings. It is advised to retain the services of an experienced health attorney to guide through the audit process and to ensure compliance. When responding to a Medicare audit, it is important to provide all requested information, ensure legibility of medical records, avoid altering records, and provide complete and accurate copies of records. Including a summary of patient care, explanatory notes, and supporting documents can also be helpful. The presenter advises keeping copies of all correspondence and documents provided and consulting with an attorney to contest audit findings if necessary.<br /><br />Overall, the document provides tips for educating providers, discusses benchmarking for audits, outlines different types of payer audits, and offers guidance on how to respond to audits conducted by various organizations.

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Keywords

auditing physicians

coding and billing issues

benchmarking

Evaluation & Management codes

audits

fraud

health attorney

Medicare audit

legibility of medical records

contest audit findings

Coding

Billing

Documentation

Evaluation and Management Coding

Audit

Falsified Record