From time to time you will see requests for medical inspectors or audit hearing panel members. You may wonder why anyone would want to be a medical inspector and audit their peers.

When the Audit and Inspection Committee (AIC) orders an on-site audit, the Billing Integrity Program attempts to match the medical inspector with the type of practice undergoing the audit. Having a peer physician conduct the review is in the best interest of the physician undergoing the audit and inspection. As a medical inspector, not only will you help see a colleague through the audit process, you will gain experience and education along the way.

The AIC is accepting applications for medical inspectors from any section, but currently they are looking specifically for general practitioners, internal medicine physicians and subspecialists, infectious-disease specialists, endocrinologists, rheumatologists, general surgeons and surgical subspecialists, thoracic surgeons, neurosurgeons, otolaryngologists, ophthalmologists, anesthesiologists, psychiatrists, and pediatricians.

Inspectors appointed under the Medicare Protection Act inspect medical records to assess compliance with the payment schedule, the Act, and the Regulations. Inspectors are appointed by the AIC.

Conditions of appointment

Candidates must:

• Have a minimum of 5 years’ experience in the applicable specialty.
• Be an active registrant with the College of Physicians and Surgeons of
• Have practices that fall 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.

Inspectors are required to:

• Sign a 3-year contract, with possible 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 will be paid an hourly rate derived from the hourly equivalent of the Doctors of BC’s 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 Juanita Grant, manager, audit and billing, Physician and External Affairs at 604 638-2829 or jgrant@doctorsofbc.ca.
—Lorne Verhulst, 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, manager, audit and billing, Physician and External Affairs, at 604 638-2829 or jgrant@doctorsofbc.ca.