Handling Unannounced Audit Visits
By Albert R. Meyer, JD, MHA
You think you are doing things right, but a stranger or two walks into your office and identifies themselves as a representative of the Medicare program. They wish to review certain patient files and/or interview the health care providers and staff. This unnerving experience is becoming commonplace in today’s health care system. With that said, taking proactive measures and being prepared before the knock on the door can make this process less painful.
The most important thing when handling announced audits is to have policies and procedures in place BEFORE you get a visit from state or federal regulators or their designees. A knowledgeable health care attorney or consultant can assist you in developing a set of procedures that are appropriate to your particular practice. If you only do one thing to address audits, the most important element is to designate ONE person to speak with the auditors. Often it is the office manager. However, if your office manager is not capable of this role, the principal provider in the practice should be the designated person.
If you do not have set policies and procedures in place the following actions may make this stressful process be a smooth as possible:
• Contact your attorney immediately.
• Be polite and professional. The auditors at your office are just doing their job, just like you. Also, they are human and will likely act in a similar manner as the way they are received. It could mean the difference between the auditors limiting their activities to what is in their order and looking for any information they can find to “get you.”
• Remind the auditors that they are not permitted to disrupt patient care that is going on.
• Say as little as possible and let the officer manager be the primary communicator.
• DO NOT agree to an interview. You are not obligated to be interviewed.
• You can inform your employees that they are not required to speak with the auditors, but you cannot stop them from talking to them.
• Let the auditors know that your polices mandate that your attorney be contacted before you agree to anything and allow them to wait while your attorney is being contacted.
A knowledgeable healthcare attorney will communicate to the lead investigator and inform him/her that there will be no interview without attorney being present. Before any interview takes place, your attorney will instruct you not to sign any forms or notes and will work with the auditors to determine what information is necessary. Ideally, the attorney will request the auditors to send questions in writing to your attorney, allowing a reasonable time for a response and set the ground rules for the visit.
Following these steps and the advice of an experienced health care attorney can make this painful process hurt less.
Mr. Meyer is an attorney with over 20 years’ experience in health care law focusing on regulatory and transactional matters. His clients include physicians, medical equipment companies, surgery centers and diagnostic centers. He can be reached at 866-585-5444 or firstname.lastname@example.org.