I am frequently asked by physicians, “What could get me audited?” There is no simple answer.
In any system that pays for services, there is an audit process. Approximately 103 million claims are processed each year by Health Insurance BC. The system allows physicians to submit billings in most cases without pre-approval. The system is built on trust and is designed to pay. As a result, physicians may continue to bill incorrectly for many years, and it is not until they are audited that they become aware of a problem.
By heeding the following advice you may reduce the chances of triggering an audit and also reduce the chances of a bad outcome if you are audited:
You are accountable for what is billed under your MSP billing number. Passing the blame will not help you if you are audited.
—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This article is the opinion of the Patterns of Practice Committee and has not been peer reviewed by the BCMJ Editorial Board.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 [10].
Links
[1] https://bcmj.org/cover/julyaugust-2016
[2] https://bcmj.org/author/keith-j-white-md
[3] https://bcmj.org/node/99
[4] https://bcmj.org/sites/default/files/BCMJ_Vol58_No6_billing_tips%20%28ID%20106051%29.pdf
[5] https://bcmj.org/print/billing-tips/billing-and-audit-avoiding-pitfalls
[6] https://bcmj.org/printmail/billing-tips/billing-and-audit-avoiding-pitfalls
[7] http://www.facebook.com/share.php?u=https://bcmj.org/print/billing-tips/billing-and-audit-avoiding-pitfalls
[8] https://twitter.com/intent/tweet?text=Billing and audit: Avoiding the pitfalls&url=https://bcmj.org/print/billing-tips/billing-and-audit-avoiding-pitfalls&via=BCMedicalJrnl&tw_p=tweetbutton
[9] https://bcmj.org/javascript%3A%3B
[10] mailto:jgrant@doctorsofbc.ca
[11] https://bcmj.org/modal_forms/nojs/webform/176
[12] https://bcmj.org/%3Finline%3Dtrue%23citationpop