OMT Audit Update
Friday, May 31, 2013
Posted by: David Walls
As many of you know, OPSO has been working closely with Regence Blue Cross Blue Shield of Oregon to address the complaints we have received from many of our members. Members had voiced concerns of overreaching insurance audits , especially those physicians who provide OMT.
In meetings with Regence Medical Director, Csaba Mera, MD, Regence has agreed to suspend the contested insurance audits given the confusion surrounding the current audit process. We have been continuing our discussions with Regence and met again with Dr. Mera on May 8th. In this meeting Yolanda Doss, Monica Horton, and Boyd Buser, DO from the AOA, and David Walls with OPSO responded to the ongoing audit concerns. Overall, the meeting was productive and Regence confirmed that they would be refunding monies that were recouped as a result of the
OPSO has heard from several physicians that have continued to
receive requests for refunds of monies paid. Regence has reported a glitch in their automated letter system that has continued
sending requests for payment recoupment. Dr. Mera made it clear that Regence is not seeking any payment recoupments and confirmed all audits and current
requests for refunds are terminated. Dr. Mera did not have an exact date
regarding how far they would go back with repayments, but said it would be at
least through December 2012.
If you have received a letter from Regence requesting a payment recoupment as the result of an audit, or if you have received a request for a new audit, please contact your provider relations representative and copy OPSO with the information. If your provider relations representative is unable to assist you (or you are unable to reach them), please contact OPSO and we will assist you.
OPSO is continuing to monitor the situation and asks that all members continue to keep us updated if you have any ongoing audit concerns. OPSO will reassess the situation in the next few weeks and a follow-up survey will be sent to all members. With this information, OPSO will determine the next course of action, so please make sure to complete the survey, even if you have not been affected by an insurance audit.
As always, if you need additional information or would like to share your concerns, please contact the OPSO office at 503.299.6776 or email firstname.lastname@example.org