This 2-Minute Monday Personal Injury Mindset is about a microscope no one wants on their business or themselves.
Avoid Audits of Your Practice at All Costs
What I tell my CPA every year at tax time is simple: “Make sure I never get audited and if I do, that I win.”
No red flags. No attention. Because even when you win an IRS audit, you still lose … time, stress, focus, professional fees. And if you lose, ouch!
Medicine is no different, except the consequences are far worse. Right now, insurers are tightening documentation standards. CMS and private payers aggressively request records, and providers are facing massive payback demands when documentation doesn’t meet heightened requirements. AI-driven payer systems are flagging patterns and causing an increase in denials, delays and audits.
And in personal injury, the microscope gets even stronger, digging into medical necessity, cash rates versus out-of-network rates, and billing gaps that can trigger inflated billing or false charge claims.
Things can look legal and still cross gray lines faster than you think. That’s why, just like you need an ethical CPA, you also need strong processes and ethical rechecks in your practice. Because audits come from Medicare, medical boards, depositions, discovery and referrals to SIU divisions you never want.
The Office of the Inspector General recommends at least one self-audit per year. Medicare’s Learning Network gets you access to free tools, and if you meet Medicare standards, you’re usually covered everywhere else.
Use peer review or use compliance professionals.
Even use AI as a self-audit too since payers are using AI against you, a kind of AI vs AI.
Make sure to check your documentation, coding and fees, and ensuring support for medical necessity of every code. Because documentation and billing support are insulation.
Do PI right. Do your entire practice right. Avoid the audit, because this isn’t just compliance.
It’s good medicine and good business. You want to avoid audits of your practice at all costs. And you can.
