By: Keith J. White, MD
Why be a medical inspector?
Issue: BCMJ,
vol. 58, No. 1, January February 2016,
Page 43 Billing Tips
From time to time you will see requests for medical inspectors or audit hearing panel members, and you may wonder why anyone would want to be a medical inspector and audit their peers.
Inspectors are appointed by the Audit and Inspection Committee under the Medicare Protection Act to inspect medical records to assess compliance with the Payment Schedule, the Act, and the Regulations. When the Audit and Inspection Committee orders an on-site audit, the Billing Integrity Program (BIP) will match a medical inspector with the type of practice undergoing the audit. Having a peer physician conduct the review is in the best interest of the auditee. Not only does the inspector help a colleague navigate the audit process, he or she can also gain experience and education along the way.
Conditions of appointment
A candidate for a medical inspector position must meet the following requirements:
• Have a minimum of 5 years’ experience in the applicable specialty.
• Be an active registrant with the College of Physicians and Surgeons of BC.
• Have a practice that falls within the accepted standards of the profession or generally designated by the Patterns of Practice Committee (POPC).
• Be supportive of the policies and principles of the POPC and licensing body.
• Have the ability to exercise sound judgment.
• Have an understanding and knowledge of the MSC payment schedule.
• Not be subject to circumstances that could give rise to a conflict of interest.
Responsibilities of the role
Inspectors are required to commit to and carry out the following responsibilities:
• Sign a 3-year contract, with the possibility of an extension, with the Ministry of Health.
• Attend an orientation and training session.
• Maintain confidentiality and independence at all times as required by Section 49 of the Act.
• Work as part of a team while on site.
• Attend on-site audits, which may include travel and stay at accommodations outside the medical inspector’s city (length varies from 3 to 5 days).
• Inspect medical records, make determinations about compliance with the Payment Schedule, and flag any quality-of-care concerns.
• Have an exit interview with the auditee to clear any unanswered questions or to obtain explanations of billing issues.
• Review and sign final audit reports.
• Act as a witness before a panel established under the Act, if necessary.
Compensation
Medical inspectors are paid an hourly rate derived from the hourly equivalent of the Doctors of BC sessional rate for GPs or specialists. Inspectors will also receive compensation for eligible travel expenses.
If you are interested in becoming a medical inspector, please contact Ms Juanita Grant, audit and billing advisor, Physician and External Affairs, at 604 638-2829 or jgrant@doctorsofbc.ca.
—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.