Avoiding an Audit

Being audited is an overwhelming and extremely stressful time in a physician’s life. If you are being audited, your first thought is likely “why me?” While there is no simple answer, there are a number of steps you can take to help prevent finding yourself in the midst of an audit.

Approximately 103 million claims are processed by MSP per year, the majority of which are done without pre-approval. This is because the system is built on trust and designed to pay. It also means that physicians who bill incorrectly may do so for years, not realizing their error until they are audited.

The following advice may reduce your chances of triggering an audit and also reduce your chances of a bad outcome if you are audited:

• Don’t rely on MSP to tell you that you did not bill something correctly. Just because you billed for it and were paid does not mean that you billed correctly;
• Take the time to document what you do;
• Read the Preamble to the Payment Schedule and your section of the Doctors of BC Fee Guide;
• Ensure all lab or diagnostic tests you order are medically necessary;
• Do not destroy appointment records;
• Look at your remittances; if something doesn’t look right, phone MSP;
• If you get advice from MSP billing support, document who, what and when;
• Be cautious about relying on billing advice from colleagues and private pay companies.

Mini-Profiles

Another important audit tool is your Mini-Profile. Produced annually and available on the Doctors of BC website, your profile helps educate you on your pattern of billing. Mini-profiles are provided to all fee-for-service (FFS) physicians (after 1 year FFS earnings of at least $1,000), based on the claims data submitted for payment to the MSP. They are designed to be user friendly and to provide a good comparison of a physician’s practice with other colleagues in their comparison group. Adjustments of the data have become increasingly more sophisticated. Comparisons not only involve age and gender distribution, but also comparisons based on burden of illness and continuity of care.