Auditing charts is nothing new; Medicare has been doing such audits for years. They are looking for coding irregularities within a practice to determine if they want to do a more extensive audit. That’s when a practice gets the dreaded notice to prepare and submit charting documentation on a selected number of charts and submit them to CMS for a detailed review. Often when this happens the stakeholders in the practice have no idea what they have done to trigger the audit.

We suggest you take a proactive approach to understand your coding patterns and whether you are coding appropriately based on the services rendered and the documentation essential to support the codes you billed for. Here are steps you can take to prepare for a practice-wide internal audit, which may help you avoid the dreaded Medicare audit – or at least be ready to pass with flying colors.

  1. Empower staff to understand the importance of their individual actions in helping the practice get paid for the services performed. A mini audit involves everyone in analyzing charge and payments for services rendered.  The staff teams up to examine documentation of services rendered, diagnostic coding for encounters and the payment received for those services.
  2. Increase the staff’s awareness of the significance of accurate documentation and its relationship to revenue generated in the practice.  By examining charts and billing information the staff will begin to understand how important it is to account for every single service rendered. With reduced reimbursement no office can afford to drop a charge or to neglect following up on an inappropriate reduction in reimbursement.   For example if you missed charging for one EKG and one Urinalysis a day, it would add up to as much as $12,000 a year in lost revenue.  If you missed charging for one hospital consultation a month per doctor in a four doctor practice, you would take an annual hit of $6,000.
  3. Increase the reimbursement IQ of reception and nursing staff, as they examine EOB’s and see a 30 to 40% adjustment in the payment rendered by third party payers. This will help everyone understand why the physicians and staff are working harder without seeing an increase in revenue.   They will have a better understanding of why it is important to capture every charge.
  4. Identify discrepancies in documentation for an encounter by examining the information related to  a specific date of service and compare the services  documented on the appointment record , in the chart (including E&M services, procedures, and tests recorded), the charge slip, the computer record (patient ledger) and  for service rendered for an encounter , the service and diagnostic codes entered  on the charge slip and the insurance form (HCFA1500), and the explanation of benefits provides by the third party payer when payment was issued.

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