Physicians Advocacy Institute Seeks Fairer Medicare Audit Process

A recent letter from North Carolina Medical Society (NCMS) CEO Robert Seligson in his role as president of the Physicians Advocacy Institute (PAI) urges Nancy J. Griswold, Esq., the Chief Administrative Law Judge for the Office of Medicare Hearings and Appeals (OMHA) to make medical audits and the audit appeals process fairer and more transparent.

“We recognize and appreciate that OMHA has already undertaken several measures to address the backlog of appealed provider claims. However, PAI believes that the easiest way to decrease the appellate workload and backlog is to reduce the need for appeals in the first place by implementing additional measures to ensure that provider audits are conducted consistently and accurately,” the letter states. “The high percentage of recovery audit contractor (RAC) determinations that are overturned in favor of providers at the OMHA ALJ level demonstrate the critical need to address the inherent problems within the current audit process.”

Read the specific recommendations outlined in the letter as well as a white paper from PAI on what physicians need to know about medical audits.


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