What You Need to Know about Medical Audits

Audits and payment recovery actions are hitting doctors with increasing frequency and intensity. The Physicians Advocacy Institute (PAI), in collaboration with NCMS and other state medical associations, has developed a new resource to help physicians avoid and respond to audits and financial reviews conducted by Medicare, Medicaid and private payers. Medical Audits: What Physicians Need to Know explains the various types of audits and how to appeal adverse audit findings.

“This is an important member benefit that will help physicians to prepare for the challenges they face from the business side of their practices,” NCMS EVP, CEO Robert W. Seligson said. “Understanding the types of audits and how to respond to them helps practices to better identify and correct errors in billing and coding, as well revealing when auditors might err in their findings.” Mr. Seligson serves as president of the PAI.

This white paper is available on the NCMS Fraud and Abuse webpage, where you will find other helpful resources covering Medicare and Medicaid audits. The principle author of the paper is Mr. Frank Cohen, a renowned expert in health care analytics and data mining, and a consultant to physicians and medical associations nationwide.

The NCMS is a signatory member of the PAI, which was formed in 2006 as a result of class action settlements with major national health insurers. Even though most of the settlement agreements have expired, the PAI continues to develop projects and tools that guarantee the viability of physician practices and the ability of physicians to deliver quality patient care. Read more about PAI at http://www.hmosettlements.com/.


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