Hayes Wanamaker, MD, an otolaryngologist in Syracuse, N.Y., refers to the recovery audit process of insurance carriers as the proverbial camel’s nose under the tent.
Explore this issue:July 2010
A partner at Central New York ENT Consultants and chief of otolaryngology at Crouse Hospital in Syracuse, Dr. Wanamaker has been audited by carriers several times in the past few years, and the experience is always similar: The insurance company comes into the physician’s office on a premise like the review of billing directly related to treatment of allergy-related issues. But, while culling through records related to that topic, the insurer starts looking at evaluation and management coding, extrapolates a package of records over the course of the practice and then presents the audited office with a bill that can easily be in the hundreds of thousands of dollars.
“You may get a $300,000 request for a repayment reduced to $50,000 or $100,000, and it will cost you $30,000, $40,000, $50,000 in legal fees,” Dr. Wanamaker said. “They make it so painful to challenge them or take them on that it can ruin your practice.”