Delivering audit results to healthcare providers is rarely a straightforward task. When the data points to clear deficiencies—particularly those stemming directly from a physician’s documentation, coding choices, or clinical behavior—the conversation can quickly turn from professional review to defensive standoff. Healthcare auditors, coders, and compliance professionals are tasked with providing clear, unbiased feedback that ultimately serves the practice, protects compliance, and ensures appropriate payment. But what happens when those results are less than favorable, and the physician in question dismisses your findings or shifts blame elsewhere?

This article explores practical strategies for delivering audit results when the conversation gets uncomfortable—and how to transform these difficult moments into opportunities for education, collaboration, and improved outcomes.

The Nature of the Beast: Why Audit Results Stir Strong Emotions

Audits, particularly those that identify consistent errors, strike at the heart of a physician’s professional identity. Many physicians/APPs (advanced practice providers) view their clinical judgment, documentation style, and billing practices as extensions of their personal expertise. When those are called into question, the immediate reaction is often defense, denial, or even dismissal of the auditor’s competency.

Phrases similar to the following are all too common:

• “That’s how I’ve always done it.”
• “I’ve been coding this way for 20 years.”
• “My notes are fine—the coders just don’t understand my specialty.”
  
  

Add to this the fact that healthcare compliance rules evolve constantly, and physicians/APPs often feel they’re being judged against moving goalposts. In this environment, delivering poor audit results becomes more than a review; it becomes a delicate balancing act of diplomacy, education, and fact-based feedback.

The Art of the Delivery: It’s Not What You Say, It’s How You Say It

When audit results reveal physician-specific patterns of error, how you present the findings is critical. 

Here’s a roadmap to maintaining professionalism while holding firm to the facts:

• Lead with data, not opinion. Physicians/APPs respect evidence. Frame your results around the objective data from the audit, not subjective interpretation. Instead of simply stating, "Your documentation is incomplete," specify, "In 14 of the 20 records reviewed, the medical decision making documentation lacked required components to support the level of service billed." Concrete data is harder to argue with and shifts the conversation away from personal critique.
  
  
• Acknowledge the complexity of compliance. Position yourself as a collaborative resource, not an adversary. Recognize the challenges that physicians face—balancing patient care with ever-evolving documentation rules—and position your audit as a necessary tool for protecting the practice. Try: "We know the rules have changed significantly in recent years, and we’re here to help everyone stay on the right side of compliance."
  
  
• Diffuse defensiveness with a team approach. When a physician/APP tries to deflect blame onto the coding team, billing staff, or even EHR templates, redirect the conversation to focus on shared responsibility. Remind them, "Documentation is a team effort, and it’s common for there to be gaps between clinical intent and how it translates into the record. Our goal is to help close those gaps together."

When the Physician/APP Dismisses Your Expertise

Difficult physicians/APPs often dismiss audit results outright, or worse, attempt to undermine the auditor’s credibility. 

In these situations:

• Stay calm and professional. Don’t engage in emotional back-and-forth.
• Anchor to regulations and guidance. Cite official sources like CMS, the OIG, or specialty-specific guidelines to reinforce your findings.
• Offer a second opinion option. If the physician/APP insists you’re wrong, offer to bring in a third-party auditor or a medical director review. Objectivity is your greatest ally.
• Document the encounter. If hostility escalates, maintain detailed notes about the conversation for compliance purposes. If the situation becomes overly aggressive or unproductive, it’s perfectly appropriate to end the meeting and reschedule once cooler heads prevail.

The Fine Line Between Blame and Accountability

One of the most challenging aspects of delivering audit results is when the data makes it clear that the physician/APP is, in fact, the source of recurring issues, whether it’s upcoding, missing documentation, or medically unnecessary services. In these cases, your goal is to shift the focus from blame to improvement.

Consider the following phrase: "The audit identified a pattern that presents an opportunity for documentation improvement. Here’s how we can address it moving forward." This allows you to maintain accuracy without alienating the physician.

If the physician/APP consistently refuses to accept responsibility, it may be necessary to escalate the issue to leadership—framing it not as an attack on the physician/APP, but as a compliance risk for the entire organization.

When It’s Clear They’re the Problem—But You Can’t Say It That Way

In rare cases, audits uncover behavior that goes beyond documentation errors into the realm of intentional misconduct or complete disregard for compliance. When this happens, your language must be even more measured.

Emphasize the following:

• Risk to the Practice: Highlight the potential for audits by external payors, financial penalties, and reputational damage.
• Focus on Process, Not Person: Frame recommendations around improving workflows, templates, and training rather than targeting the physician/APP personally (even if they are the root cause).
• Leverage Leadership: If a physician/APP refuses to engage in corrective action, involve practice leadership to emphasize the organizational stakes.

Turning Audit Results Into Positive Change

Ultimately, the goal of any audit isn’t to assign blame; it’s to improve accuracy, compliance, and reimbursement integrity. 

The most successful audit debriefs:

• Emphasize education over correction.
• Focus on future improvement, not past mistakes.
• Align audit goals with the physician’s own goals (faster claims processing, fewer denials, reduced payor scrutiny).
• Create a collaborative action plan with clear next steps.

Compliance Is a Culture, Not a Critique

Audit results should never be viewed as a personal indictment. The more we shift audits from being seen as punitive events to being seen as valuable checkpoints for clinical and financial health, the easier these conversations become—even with difficult physicians.

When auditors, coders, and compliance professionals position themselves as trusted advisors, rather than the “compliance police,” they not only deliver audit results more effectively—they foster a culture where compliance becomes everyone’s responsibility.

By embracing transparency, objectivity, and a spirit of partnership, we can transform even the most challenging audit conversations into opportunities for growth and stronger, more resilient practices. 

Betty A. Hovey, BSHAM, CCS-P, CDIP, CPC, COC, CPMA, CPCD, CPB, CPC-I, is a nationally recognized healthcare consultant and speaker. She is an expert auditor and loves to help practices stay compliant and profitable. Betty states, “Physicians work hard for their practices and they should be paid properly for what they do.”

Betty brings over thirty years of healthcare experience. She has worked for practices both large and small with the same intensity and attention. She has spent years on the “front lines” for practices handling medical billing, coding, claims, and denials. She has also managed practices and directed healthcare system departments. Her areas of expertise include Evaluation and Management, Primary Care, Dermatology, Plastic Surgery, Cardiology, Cardiothoracic Surgery, General Surgery, GI, E/M and procedural auditing, and ICD-10-CM.

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