Physician Practice Audit Targets Now Become Hospital and Health System Compliance Risks.

Area of Science:

• Healthcare economics
• Medical billing and coding
• Healthcare policy

Background:

• Rising healthcare expenditures, with Medicare and Medicaid consuming 22% of the federal budget in 2013.
• Projected depletion of the Medicare Trust Fund by 2030.
• Significant error rates in Medicare fee-for-service payments (over 12% in 2014).

Purpose of the Study:

• To address the increasing pressure from Congress to reduce improper payments.
• To shift focus from hospital billing to physician billing practices.
• To provide actionable strategies for preventing and managing billing denials.

Main Methods:

• Analysis of common physician billing audit targets.
• Identification of frequent billing errors made by physicians.
• Review of strategies for responding to audits and denials.

Main Results:

• Hospitals acquiring physician practices are increasingly liable for physician billing errors.
• Independent physicians face significant financial risks from audits and denials.
• Prevention of improper payments is crucial for financial stability.

Conclusions:

• Physician billing practices are under increased scrutiny due to rising healthcare costs and payment errors.
• Proactive strategies are essential for physician practices and health systems to avoid financial penalties.
• Implementing robust prevention measures can mitigate the impact of audits and denials.