This is the third article in a series of four. The subject of this article is phase 3: reporting.
What happens after your on-site audit takes place? When will you know the results?
After the on-site audit is complete the senior auditor prepares a preliminary error list from the medical inspector’s audit working papers. The list of preliminary errors is provided to the auditee for a response within 30 days. This is an opportunity for the auditee to provide any additional records that were not available during the on-site audit. In exceptional circumstances extensions to the 30-day response timeframe may be granted.
If the auditee submits additional records or relevant information, the medical inspector will review those files as part of the audit. If applicable, further records may also be requested from hospitals, care homes, etc. All information will be analyzed for consideration in the audit report.
If the auditee does not provide additional records, the audit report will be prepared from the information gathered during the on-site audit.
Once all pertinent information has been gathered the audit manager drafts an audit report. The senior auditor and the medical inspector sign the draft report and it is presented to the Audit and Inspection Committee (AIC) for approval. The AIC provides a recommendation to the Medical Services Commission to either pursue recovery or close the case. A copy of the approved audit report is also provided to the auditee.
If the case is closed the auditee will be informed in writing. If a decision is made to pursue recovery, the recovery phase will commence.
Currently, completion of the audit report takes approximately 9 months to 1 year. The Billing Integrity Program is working to reduce the amount of time that this phase requires.
The next phase of the audit process is recovery. Watch for the final article in the December BCMJ.
—Keith J. White, MD, Chair, Patterns of Practice Committee
This article is the opinion of the Patterns of Practice Committee and has not been peer reviewed by the BCMJ Editorial Board. For further information contact Juanita Grant, audit and billing advisor, Physician and External Affairs, at 604 638-2829 or firstname.lastname@example.org.
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
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- Page numbers are not abbreviated.
For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org