Episode # 3 • 17 Jan 2025
Medicare Audits Explained: Impact on Physicians & Practices
with Jason Greis, Dr. Aparna Baheti
What do you actually do when a Medicare audit letter lands in your inbox? On this episode of BackTable Podcast, Dr. Ally Baheti interviews healthcare attorney Jason Greis, partner at Benesch, to demystify the audit process and the rising scrutiny on interventional practices. They discuss why audits are accelerating, which procedures are under the microscope, and how enforcement economics and AI-driven review are reshaping the landscape for OBLs and ASCs.
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Timestamps
00:00 - Introduction
02:32 - Audit Hotspots in Endovascular Work
05:00 - AI Oversight and Proactive Compliance
13:35 - The Alphabet Soup of Audit Types
19:16 - Responding to an Audit and the Appeals Ladder
24:48 - Employment Status, Liability and AI Downcoding
30:29 - Final Advice and Wrap Up
Resources
- OIG: Utilization Trends and Medicare Part B Billing for Office-Based Peripheral Vascular Procedures Raise Questions About Program Integrity (OEI-01-24-00250)
- CMS Wasteful and Inappropriate Service Reduction (WISeR) Model
- CMS Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH)
- CMS Medicare Fee-for-Service Appeals: The Five Levels
- CMS Medicare Fee-for-Service Compliance Programs (TPE, RAC, SMRC, CERT)
- BackTable VI Ep. 478: ASC vs. OBL: Legal Insights Explained
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More about this episode
The conversation covers the “alphabet soup” of audit types, the five-step appeals process, and strategies for proactive compliance and documentation. The discussion walks through personal liability, employment status, the risks of algorithmic downcoding by commercial payers, and why practices must balance when to fight and when to let an audit go. The episode closes with actionable advice on protecting your practice, the dangers of putting patient data into AI tools, and why trade organizations are the first line of defense.
The Materials available on BackTable are provided for informational and educational purposes only and are not a substitute for the independent professional judgment of a qualified healthcare professional in diagnosing or treating patients. Any opinions, statements, or views expressed are those of the individual contributors and do not necessarily reflect those of the publisher, platform, or any affiliated organization.