Why might services provided by teaching physicians be denied during audits?

Services provided by teaching physicians may be denied during audits primarily due to the requirement of proper documentation demonstrating a face-to-face encounter between the physician and the patient. Teaching physicians, who supervise residents, must ensure their involvement in the patient’s care is clearly documented; this is critical to validate the medical necessity and appropriateness of the billed services.

When a teaching physician is involved in patient care, regulations mandate that there must be a direct interaction with the patient for the service to be billable. If the documentation does not reflect this encounter adequately, it can lead to denials because auditors look for evidential support that meetings occurred as described. This requirement ensures compliance with billing regulations and standards, safeguarding against inappropriate billing practices.

Therefore, insufficient or unclear documentation regarding face-to-face interactions is a common reason for denial during audits, as it fails to meet the criteria set by payers for justification of billed services rendered.