Practice Management Institute to Address Growing Incidence of Automated Audit Letters Arriving in Physician Practices

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An audit letter from an outside intermediary can send physician office operations into a tailspin. Practice Management Institute will present a webinar on August 3, 2010, to help office staff prepare to appropriately handle this operational and financial hot potato.

The Practice Management Institute® (PMI) will conduct a webinar on Wednesday, August 3 that will address the growing incidence of automated audit review letters arriving in physician mailboxes. An audit letter from an outside intermediary can send office operations into a tailspin. PMI will go over a plan that office staff should have in place to appropriately handle this operational and financial hot potato.

Physicians who bill fee-for-service programs are subject to review by Recovery Audit Contractors (RACs). RACs use proprietary software programs to identify potential payment errors in such areas as duplicate payments, fiscal intermediaries' mistakes, medical necessity and coding. CMS reported that from the inception of the RAC demonstration through August 31, 2008, providers chose to appeal 22.5 percent of the RAC determinations. Overall, the data indicate that of all the RAC overpayment determinations (525,133), only 7.6 percent were overturned on appeal.

“Medicare begins recouping funds only 30 days after the RAC’s initial determination and only 60 days after its redetermination decision,” said Robert Liles, JD, managing member, Liles Parker, PLLC, a Washington DC-based law office specializing in healthcare fraud and abuse allegations. “This puts significant pressure on providers to file for first and second level appeals more rapidly than they otherwise might. In later stages, recoupment cannot be stayed by filing the appeal.”

RACs also conduct medical record reviews. Errors can happen on both ends. Computer hiccups can cause claim denials and trigger an automated audit review. Collins and Teter will explain how to research allegations internally to verify or debunk audit review letter claims.

“Physicians and their billing staff must be on the lookout for errors well before a letter from a RAC arrives,” said Maxine Collins, MBA, CPA, CMC, CMIS, CMOM, co-presenter of the broadcast for physicians and their staff. “It’s important to take a proactive stance so that you know what to do if your practice receives an audit letter.”

Collins is the former administrator of a multi-specialty clinic and has taught numerous practice management, accounting and business communications courses. She has extensive experience as a practice consultant and has taught both administrative and clinical personnel.

Maggie Teter, CMC, CMIS, CMOM, will join Collins as co-presenter. She is the primary coder for a busy surgical practice, where she is responsible for accounts receivable/collections, billing, preauthorizations and referrals, as well as implementation, training, and monitoring of practice compliance programs. has comprehensive knowledge of medical practice management, coding, billing, claim resolution, and regulatory policies relevant to the practice.

The webinar will address important questions for every practice:

  •     What is an automated audit review/request and how to respond?
  •     What is the best way to prepare for an audit?
  •     What is the likelihood of a RAC audit?
  •     How far back can the RACs review claims and how many records can be requested?
  •     What to do upon receiving a CMS MMA 935 letter requesting recoupment?

The live webinar, entitled, “The Audit Letter is here…Now What?” is accessible via a phone line and web connection. The connection fee is $199 per listening site. Physicians and their staff may listen together from a single phone line/speaker phone for no extra charge. There will be a question and answer time period allotted during the call. Dial (800) 259-5562 before August 3 to pre-register for the webinar. Online registration available at: http://www.pmiMD.com/audio/default.asp.

Practice Management Institute® (PMI) is the training, networking and credentialing source for medical office professionals. For more than 25 years, physicians and their staff have looked to PMI for skills that contribute to a more efficient, profitable and compliant office. Classes are hosted in 400 of the nation’s leading hospitals, medical societies and colleges. PMI awards certification by exam to accomplished medical office coding, reimbursement, and management professionals. More than 15,000 medical office professionals have earned their credentials through PMI.

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Nancy Clements