Office Based Surgical Procedure Audits: How to Handle Them  

Category: Auditing

Regrettably, many physicians are receiving a letter from an insurance carrier informing them that they must repay a substantial amount of money as a result of what has been billed to the insurance carrier and paid without objection. Perhaps the most frustrating part of all is that the physician has billed the insurance company in a particular manner for years with full disclosure and the approval from the insurance carrier.   Without warning, the insurance carrier informs you that it is changing its policy as to the physicians past billing and is changing the method of billing for future services. That is the current situation faced by an increasing number of physicians, who for years, with the explicit approval of insurance companies, have been billing a separate facility fee in connection with the performing of office-based surgical procedures. 

The typical s...