Academy Assistance with Payer Audits

If either the Academy, a Board member or a Physician Payment Policy workgroup member is asked by an insurance company to review a medical record from a member’s office, the request should be forward to the Assistant Director of Health Policy. The individual, whose records are being reviewed, will be contacted. They will be asked if they want the AAO-HNS to assist in reviewing the medical charts and offer an opinion as to the appropriateness for the documentation and coding. If the member agrees, then selected members of the Physician Payment Policy workgroup and the Academy’s Assistant Director will review the blinded records. If the member disagrees, they will be informed that a later request on the same action, by such member, will be evaluated on a case-by-case basis. After the records are reviewed, all parties involved will be notified of the audit findings.

Adopted: September 24, 2005

Guidelines are not a substitute for the experience and judgment of a physician and are developed to enhance the physicians' ability to practice evidence-based medicine.

Important Notice

The American Academy of Otolaryngology-Head and Neck Surgery, Inc. and Foundation (AAO-HNS/F) Policy Statements are guidelines only. In no sense do they represent a standard of care. The applicability of an indicator for a procedure, and/or of the process or outcome criteria, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these guidelines will not ensure successful treatment in every situation. The AAO-HNS emphasizes that these policies should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results.