What can psychologists do about an unfavorable audit determination?
Respond to an unfavorable audit by asking for a reconsideration. A psychologist may do so by writing to the carrier and explaining clearly and in detail why each service in question is reasonable and necessary. Request a fair hearing if the results of the reconsideration are unsatisfactory. Q: What does a fair hearing involve? A: There are three different types of fair hearings. An “on the record” hearing means that a decision will be made based on information contained in the case file. A hearing conducted by telephone allows the provider to present oral testimony to supplement the case file. At an “in person” hearing, the provider is able to present both oral testimony and written evidence. Health professionals stand the greatest chance for a favorable outcome if they appear in person for a hearing. Since Medicare requirements vary among geographic areas, your local insurance carrier for Medicare and the appropriate state psychological association are good information contacts. The A
