June 30, 2020

I received an overpayment letter from an insurer.  Is there a moratorium on audits?  What is my next step here?  

Thank you,
Dr. G


Auditors and investigators, insurers and licensing/other government agencies are back to work and active.  As if a pandemic and murder hornets were not enough, we now have SIU and OPMC/OPD rapidly firing out correspondence and demands.   Our office has clocked a surprising number of audit and interview (by phone) requests in the past 4 weeks.  So, while you are still fighting with assistants to work, adjusting to a decrease in patient volume and an uptick in PPE expense, “big brother” is paying attention.  What to do? Be responsive (with the help of counsel) if you receive an inquiry.  If you have not received an inquiry, well, we should all assume we’ve been jinxed this year and to expect an inquiry.  Allow this email to serve as a reminder to document, document, document appropriately.   And, document not just patient encounters, but employee encounters, patient requests, vendor relationships, etc.  

If you aren’t sure if you are documenting appropriately or enough, ask.  Today I looked at an OPMC inquiry started by a patient who reported a practice for not responding to a request for his record.  Meanwhile, the patient failed to properly fill out a written request for his record, and after having done so, failed to respond to inquiries by the practice to correct and confirm modality of transmission or respond to the practice's request the patient pick up the record, which was available.  (Why didn't the practice mail?  The reason cited on the partially completed form requesting record cited the patient had moved out of radius and was transferring care.)  Even an innocuous-ly seeming complaint such as this can bring licensure and monetary exposure (a pox on your house).  What did the practice do wrong in the example I am referencing? Not a lot; but I would LOVE better documentation of the attempts to contact the patient to return for form completion and pick-up in order to substantiate the good practices deployed when responding to OPMC.