INSURANCE AUDIT AND MEDICARE AUDITS

The practice of medicine inevitably involves the use of billing codes and required documentation. As a result, the independent audit by government agencies or private insurers has become a fact of life. Inevitably, these audits are conducted by individuals not fully versed in the practice of medicine who inevitably seek to disallow various charges based upon rigid criteria. The stress of the practice of medicine can be greatly increased when the practitioner receives the dreaded request for a refund. We have undertaken several successful responses to such audits resulting in a significant reduction in the amount owed. In preparing the attorney’s response to the audit or appeal, emphasis is placed on minimizing attorneys’ fees to make the presentation cost effective. We also stress identifying and categorizing the objections to various services. In this way, the audit letter, which appears to be an overwhelming list of objections, is simplified. Our ultimate goal is to afford the client a reduction in the claimed refund exceeding the cost of legal fees in responding to the audit.