New Toolkit Helps Doctors Navigate Medical Audits

The Physicians Advocacy Institute (PAI) and the American College of Emergency Physicians (ACEP) collaborated to develop the Toolkit for Physicians Facing Medical Audits, which provides practical information and tips to help physicians anticipate medical audits, respond to auditors’ requests for medical records, and appeal erroneous audit findings. 

The toolkit includes detailed information regarding topics related to medical audits, including the various types of government and private payer audits, appellate procedures, and extrapolation methodologies used by some payers to calculate alleged overpayments.

The toolkit features resources on: 

  • Medical Audits: Top Ten Tips for Physicians to Anticipate, Respond and Protect Their Practices;
  • Tips for Physicians Facing Private Payer and Governmental Audits;
  • Checklist for Physicians Responding to Requests for Medical Records;
  • Checklist for Physicians Appealing Audit Findings;
  • Medical Audits: What Physicians Need to Know; 
  • Preparing for Physician Audits; and
  • The Significance and Implications of the Delay in the Assignment of ALJs (administrative law judges) in Medicare Part B Appeals. 

If you have questions regarding this toolkit or other PAI resources or activities, email Kelly Kenney.

TMA Executive Vice President and Chief Executive Officer Lou Goodman, PhD, is PAI treasurer, and TMA General Counsel Donald P. "Rocky" Wilcox is chair of PAI's Physician Advocacy Liaison Committee. 

Action, Dec. 1, 2014

Last Updated On

June 03, 2016

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