What specific changes does the law call for to better protect physicians during an audit?
The law requires the Centers for Medicare and Medicaid Services (CMS) to establish a standard methodology that carriers must use when deciding how to sample a physician’s claims during an audit. The CMS must establish the sampling methodology by December of this year. The law also requires Medicare carriers to follow new rules to make audits more fair to physicians. While the law failed to give a specific implementation date for many of the following provisions (unless noted), ACP will work with the CMS to make sure all the provisions are implemented in a timely manner: • Carriers cannot use attendance lists from educational sessions and seminars to target individual physicians for audits. • Random prepayment reviews are allowed only to identify a carrier-wide or Medicare program-wide error rate. This provision takes effect December 2004. • Carriers must give physicians written notice before they conduct a post-payment audit, and they must explain any findings in a way that makes it ea
