2 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J A N U A R Y 2 0 1 9
I
t's a letter you never want to receive, but it's increasingly likely
these days that your facility might get one. It first appears rather
innocuous: A federal or private payer asks you for a sample of
your billing records — say, 20 to 30 of them. They don't say why
they're asking, but you comply anyway. That letter almost certainly
means that the next letter you receive, sometimes as much as a year
later, will be a demand for recoupment of potentially years of billing
based on the carrier's audit of those patients' records.
In more than 20 years of practice, I have never seen a provider with
sufficient coverage lose personal assets in a medical malpractice law-
suit. I have, however, seen medical billing audits not only destroy a
Medical Billing Audits: The Road to Ruin
Brace for the worst if a payer asks to review your billing records.
Legal Update
Thomas L. O'Carroll, JD
• CLEAN BILL OF HEALTH? Will your billing practices stand up to a federal or commercial payer audit?
