Audit recovery: Not always dollar for dollar

Did you know that the amount you are required to pay back MSP for billing errors, which are identified in an on-site audit, is based on the entire five-year audit period?  

To put this in perspective, consider the following example:

Dr. A. has MSP billings of $1,500,000 over the five-year audit period ($300,000 per year). Following the on-site audit, it was shown that Dr. A. was inappropriately billing counseling visits when the documentation only supports an office visit. He also had multiple missing records. 

After giving Dr. A. credit for the office visits, Dr. A.’s total error rate based on dollars is 18%. The error rate is then extrapolated, using statistical tools, to all the billings over the audit period. The result will be a quantification and potential recovery of approximately $270,000.00. 

This is why it is important to make sure you are billing correctly and documenting everything that you do.  Do not assume that because you have been paid for the services you have billed that you have billed them correctly. 

Go to the Doctors of BC website under Billings and Audits for more information and other billing tips.