Here’s how an onsite physician office infusion therapy audit works

Blue Cross Blue Shield of Michigan conducts physician office infusion therapy audits to verify if paid claims are appropriate by reviewing medical records onsite at a provider’s office. To ensure minimal disruption to your practice and help you prepare for an audit, we’re outlining the following steps in the auditing process:

1. An auditor will contact your office to schedule a start date for the audit. This contact will be followed by a fax confirmation appointment letter, which will include a questionnaire and a partial patient list.
2. Upon arrival, the auditor will ask for a brief meeting, referred to as the entrance conference, with the practice representative. During this meeting, the auditor may request additional records or a “direct pull list.” A questionnaire, sent with the appointment letter, should be completed and available for review by the auditor during the entrance conference. Any questions you have regarding this questionnaire can be addressed by the auditor during this conference.
3. It’s important that a staff member familiar with your office charting system is available to explain your office’s charting format and any other important information that could assist the auditor’s chart review.
4. The auditor will scan all your office’s records into their secure laptop. But if your records are stored in an electronic medical record system, they must all be printed before the auditor arrives. It’s important that the auditor is provided with documentation that supports the paid claims, such as physician orders, administration sheets, progress notes, etc.
5. When the audit is done, the auditor will ask for a brief exit conference with the practice representative to discuss preliminary audit findings. The auditor will also provide a missing documentation list that identifies records that weren’t available during the audit. This report requires the practice representative’s signature confirming the report was submitted to the practice.
6. A second review of the scanned documentation will be performed by the auditor before the mailing of the provider’s initial result reporting letter. When the second review is done, the initial results reporting letter is sent via certified mail. This letter contains additional reports and an explanation of the appeal process that a provider can use to dispute audit results. It also includes the name and contact information for auditor and the manager in case you need to call with questions.