21 September 2021

Preparing for audit and Director’s interviews

Comment KnowCents PSR

The Medicare audit and Director of PSR interview process is extremely daunting.

This is a little check list for those of you who should have to go through this, based on my own experience.

  1. Make sure you are fully armed with the right legal representation and executive experts who are supportive and well versed with your practice pattern and your legal rights, and who you feel comfortable with. Do not attend these by yourself. You need representation and support.
  2. Make sure you are well aware of the item numbers in questions. This means:
    • Read the legislation and specific item descriptors of the items in question.
    • Seek clarification from legal experts (not your peers or friends or random social media posts) regarding your understanding of the actual item numbers.
    • Literally memorise the item number descriptor or have it in front of you so you can rely on that when giving oral submissions to the Director/Medicare about your understanding of the process and what your billing pattern means.
    • Do not deviate from this by saying things like “sometimes the consultation is like 19 minutes but I bill the long consult item number as it’s close enough”; or “I don’t really know exactly how long it took me, but I am a hard-working doctor and I always stay back at the end of the day to do my notes so I’m probably underbilling”.
  3. If after reviewing your billing, you genuinely notice that you have made mistakes, it is always better to voluntarily acknowledge and get it sorted prior to these audit/interview sessions.
    If you are in this predicament, engage a solicitor who can guide your through this process and make sure you are not inadvertently admitting guilt as it may affect how your legal team defends you in the long run. Admissions whether by default or error is always a very painful point for your legal team, so make sure you draft these voluntary acknowledgements properly. Just as most of us would engage an accountant or tax agent to make amendements on our tax returns, get a lawyer to do this properly.
  4. Leave your emotions at home. This is an administrative process and is as dry as it gets. The Director/Medicare officer is not there to be your colleague or friend. They are simply doing their job to make sure what you billed is “correct”. Treat this like a tax audit and do not take it personally.
    Understand that when we signed up to have the eligibility to bill Medicare (public funds) we signed up to be accountable to the Commonwealth for the billing. They really do not care how hard-working or what a good doctor you are. Submissions should be limited to characterising what your practice looks like, but in regards to your compliance and proving compliance, it should be as didactic and procedural as you can get.
    Your solicitor and legal team can walk you through this. It is what they do day and night when they prep their clients for court for cross-examination.
    Having been through it myself, it is really a type of art form you must master and practise, or you will face-plant.
  5. Do not all of a sudden change the way you practice. There is no need to do this if you have reviewed your work, read the item number descriptor/legislation and have sought opinion from a legal expert to give you confidence that you are doing the right thing. Although many clinicians may feel betrayed and hurt by this process of questioning – because yes, it does feel like you are a criminal – you must make sure you change your perception and have confidence in your professional abilities. By behaving like a criminal you will ensure you are regarded as such; as the old saying goes, “the first impression is the last impression”.
  6. Finally, and most importantly, the night before these interviews/audits, do what you love the most in your life. If that is wine tasting, kayaking, spending time with your loved ones or just going for a day off road trip chill-out session, do that. Nothing will prepare your mental health for these sessions and the best way to make sure you come across the best version of yourself is to ensure you practise the principle of indifference and confidence.
    If you have never harmed a patient, you know you are doing a great job in a very difficult profession. Have confidence, be your amazing fabulous self. Remember, this is a marathon and not a sprint.

If you are going through this process, please make sure you contact AHPAS (07 3036 5268 / info@ahpas.com.au), as we are here to help you and guide you through this process. You can also contact Work Legal directly (1300 223 398) if you wish to speak to a firm that has special expertise in this area of law.

Dr Anchita Karmakar is the founder and CEO of AHPAS (Australian Health Professionals Advisory Service) and a medicolegal liaison officer at Work Legal

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