I’m being audited: Reporting

This is the third article in a series of four. The subject of this article is phase 3: reporting.

What happens after your on-site audit takes place? When will you know the results?

After the on-site audit is complete the senior auditor prepares a preliminary error list from the medical inspector’s audit working papers. The list of preliminary errors is provided to the auditee for a response within 30 days. This is an opportunity for the auditee to provide any additional records that were not available during the on-site audit. In exceptional circumstances extensions to the 30-day response timeframe may be granted.

If the auditee submits additional records or relevant information, the medical inspector will review those files as part of the audit. If applicable, further records may also be requested from hospitals, care homes, etc. All information will be analyzed for consideration in the audit report.

If the auditee does not provide additional records, the audit report will be prepared from the information gathered during the on-site audit.

Once all pertinent information has been gathered the audit manager drafts an audit report. The senior auditor and the medical inspector sign the draft report and it is presented to the Audit and Inspection Committee (AIC) for approval. The AIC provides a recommendation to the Medical Services Commission to either pursue recovery or close the case. A copy of the approved audit report is also provided to the auditee.

If the case is closed the auditee will be informed in writing. If a decision is made to pursue recovery, the recovery phase will commence.

Currently, completion of the audit report takes approximately 9 months to 1 year. The Billing Integrity Program is working to reduce the amount of time that this phase requires.

The next phase of the audit process is recovery. Watch for the final article in the December BCMJ.
—Keith J. White, MD, Chair, Patterns of Practice Committee

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This article is the opinion of the Patterns of Practice Committee and has not been peer reviewed by the BCMJ Editorial Board. For further information contact Juanita Grant, audit and billing advisor, Physician and External Affairs, at 604 638-2829 or jgrant@doctorsofbc.ca.