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Medicare audit questions

Discussion in 'Australia' started by Axeman, Feb 22, 2016.

  1. Axeman

    Axeman Member


    Members do not see these Ads. Sign Up.
    Apologies if I've posted this in the wrong sub forum.

    Whilst I have never been audited by Medicare, I would like to know a bit about the auditing process if possible please- just in case I do get audited. Whilst all my GP Management Plan patient claims have been legit I must admit my letter writing/reports have been slack. I always write a letter back to GP when I receive a new/updated referral. However, I don't usually send a letter after the last visit. I have no reason for this other than poor management on my behalf. I have no excuse and I have no one else to blame for this.

    Referrals and case notes are always up to date- so no issue there.

    This is now really playing on my mind as I know if I get audited Medicare will most likely crucify me and potentially financially cripple me. I do suffer from anxiety and the fact I am thinking non stop about the possibility of an audit it is now affecting my health. I'm not a big fish in the scheme of things- I see maybe 12-15 of these patients per week but it will cripple me if I get "pinged". I have previously been content to roll the dice and gamble with the audit side of things but I've finally come to my senses and now put in place measures to do the final reports. So I'll be ok from now on but the thought of an audit any time soon quite frankly makes me physically ill and my heart is racing just typing this.

    Are Medicare audits targeted toward the high volume claimants? Or are they random?

    How many patients do they audit?

    Would it be worth while to self report "my sins" if such a system is in place?

    How far back do they audit?

    Please note I'm certainly not looking for any sympathy and I don't deserve it anyway- just looking for some info on the auditing process.

    Thanks in advance
     
  2. jos

    jos Active Member

    Sounds like you are stressing unnecessarily.
    I haven't been audited but speaking to those who have and reading info online, it doesn't seem that bad. It is just a big time wasting exercis.

    After all, their system is seriously flawed and lots of doctors have NO idea on correct protocol, so how can they expect us to be perfect?

    I keep records of patients visits as best as I can, so that letters are written, but I know it is not spot on. Eg. diabetes educators take visits off the patients allocation, without patients realising (and we have no idea)...so on our records they still have a visit left but when they go to Medicare, it is not paid, because they have been somewhere else. So, how are we supposed keep an accurate log? How do we know when the patient has used their last visit, as it may not be with us?
    The system is flawed, so STOP STRESSING :)
     
  3. surfboy

    surfboy Active Member

    Try not to obsess over it.

    This comes down to one causative problem. The onerous reporting requirements from Medicare for which we receive no financial reimbursement.

    We've all been there mate, the pressures of running a busy practice and the onerous requirement of having to write the reports after the first and fifth visit.

    You need to develop a template for which you can quickly and easily complete for each patient.
     
  4. trevor

    trevor Active Member

    Some of the GPs in our area are now doing referrals for 1 and 2 visits at a time for all their patients. So you get to write letters after each visit.
     
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