The University Record, February 11, 1997

Medical Center billing practices will be reviewed

The Medical Center is among 40 university-based medical centers across the nation which have received notification that they will be audited for Medicare billing practices by the federal government. The focus of the review will be on determining whether teaching physicians have followed Medicare's requirements for billing patient care services, including whether those services were documented appropriately.

The quality of the care provided to Medicare patients at the U-M Medical Center is not at issue, said A. Lorris Betz, M.D., interim dean of the Medical School.

The standards for billing Medicare when residents participate in patient care were recently clarified by a regulation that became effective July 1, 1996, but there have been disagreements about the prior standards. Because the audit period could extend back to 1991, the resolution of the audit standard will be an important issue. The Association of American Medical Colleges has been critical of the audits, arguing that the government is retroactively applying the regulations.

"Our physicians have not intentionally billed Medicare services incorrectly," Betz said. "We have complied with billing regulations as we've understood them in the past, and will continue to do so."

It has not been determined whether the audit will be performed by an independent third party or by federal auditors. The Medical Center must submit preliminary information, such as organizational charts, clinical practice by-laws and financial statements, by Feb. 28. The audit is expected to be completed in six to eight months.

All 125 university medical centers nationwide eventually will be reviewed.