A post-payment audit can tie up a practice for days as Medicare auditors comb through office records. Based on a sampling of as few as 15 claims, auditors may then extrapolate the results to all claims the physician has submitted for similar services during the previous four years. For example, the auditor might conclude that three of the 15 sampled claims were not medically necessary. At this point, Medicare will demand repayment plus interest within 30 days. If the physician appeals the denial, Medicare holds the money, which can add up to thousands of dollars.
Appeals can take years to resolve, during which time physicians are out their money.
Knowing this, the internist may simply cave in and settle with Medicare rather than spend another minute navigating the Medicare maze. Fortunately, many in Washington are beginning to answer no. Key members of Congress are not waiting for Secretary Thompson to act. The bill would require Medicare carriers to provide physicians written advice on how to bill for services, whenever requested. The carrier s advice would be binding in future audits.