How to Prepare for an Audit

The best way to ensure that you are prepared for an audit is to always follow CCO standards and Guidelines. You should also keep accurate, thorough and up-to-date clinical notes and financial records. Ensure your receipts follow leading practices and that you and your administrative staff keep accurate records of billing and payment information. For example, an insurer may request proof that you are collecting co-payments from your patients where required.

Other information that insurers could request include:

  • Clinical notes setting out an assessment of findings, diagnosis and plan of care for a patient or group of patients
  • Details pertaining to financial, geographic and administrative aspects of your business(es), including whether…
    • you have multiple businesses and if so where they are located
    • your business is a sole proprietorship, partnership or corporation
    • you have financially benefited from relationships with other businesses in a specified time period
  • Photographs of products or devices that you have sold or dispensed
  • Lab records, including date and proof of payment for any devices you have sold or dispensed
  • Prescriptions, referrals, or other records of clinical communication to and from other health care professionals
  • Documentation of your certification(s) where this is required to perform a certain treatment modality (e.g., acupuncture) or to prescribe or dispense a product or device

Sometimes patients may request things from their health care provider that are not permitted, either by the CCO and/or by their insurance provider. To support you in navigating these situations we developed The Patient’s Guide to Extended Health Care. This guide includes FAQs that addresses some common issues in this area.