Article by James Smith
What does proper scheduling and scrutinizing documentation have to do with your achievement? Self audit’s a process. Prior to jumping in and taking on the job, you need to gear yourself and your staff for it. As you most likely know, government payers are not the only insurers who carry out audits. Private insurance companies too audit practices; therefore you should see to it that your gastroenterology office will be left hassle-free should an auditor pay a visit. Sense of purpose: If your gastroenterology practice does not conduct regular internal audits, you are probably losing money and overlooking billing mistakes that could end up in missed billing opportunities and wrong coding. Figure out areas where your practice’s inefficiencies may be delaying payment or allowing for missed charges, while also evaluating your compliance with payer regulation and coding guidelines by learning how, when, and why to carry out internal audits. Demythologize some important elements of self audit that are embedded within the following fabrications. Myth one: Internal audits Internal audits are a way to ensure you’re on track and nothing has gone awry; as such you need to let every member of your practice including physicians and non-physician practitioners – know why you are doing an internal audit. Owing to the stigma that the word ‘audit’ brings to most people, you’d most likely have to figure out whether they are helping to bring in the right amount of money and cutting out denials. Everyone in your practice should understand that there is light at the end of the tunnel: Internal audits can bring about opportunities for education, opportunities for the development of better forms, and opportunities to tune up the practice. What’s more, internal chart audits make it possible to find and correct coding errors and self report, rather than letting the payer find them. Reality: Internal audits are the main thing that’ll protect providers. Auditing is a method of determining which providers need education related to documentation and proper code selection. As a matter of fact, a large percentage of the audit focuses on the doctor’s documentation, and not how the coders and their managers are carrying out their tasks. If staff members are apprehensive of losing their jobs, they’re misinformed. Doctors are happy to improve documentation as it keeps them from a government audit by not raising flags, and it often brings in more money. Myth two: All audits have the same approach As a matter of fact, there are two types of internal chart audits your practice needs to look at prior to determining which work best in your office.
Prospective audit — Your practice examines new claims prior to filing them.Retrospective audit — Your practice examines paid claims. A prospective audit helps you identify and rectify problems prior to sending the claim, which could mean you will discover improper coding or charges that would otherwise have been missed. However, remember that this type of chart audit can potentially delay billing. Choice: Retrospective chart audits don’t delay billing, however causes your office to be reactive by refilling claims rather than proactive in finding problems prior to submitting the claim. Your practice must figure out itself what types of audits your staff can practically complete and what effects on claims submission timing and cash flow the practice can handle. When reviewing charts, most auditing specialists recommend that you review 10 to 15 records per physician during your audit – you should examine the documentation and figure out which ICD-9 and CPT codes you think apply to the chart, then check which codes were in reality assigned to the services. Myth three: End and start audits whenever you like Schedule gives life to the whole internal audit process; minus this, all your efforts might go to waste. Depending on the size and type of your practice, you should decide how often your practice carries out an internal audit. Think about the amount of resources the practice can devote to the audit when conducting day-to-day office business. Pointer: Bear in mind that the more often you can audit, the cleaner your claims will continue. At a minimum, you should carry out an internal audit at least two times a year. After you have prepared your staff for the auditing process and determined when you will carry out an audit, you will need to define and focus on the audit. First enquire what do we want to accomplish and then focus on these points: Figure out the audit’s scope. Which providers, services, date range and payers will it address? Figure out how to choose charts. Will you fix this process for each provider or will you randomize the chart selection? Pull charts and organize supporting documentation, say for instance a printout of physician notes, account billing history, CMS 1500 forms and explanations of benefits. For more on internal audits and for other medical coding updates, stay tuned to a medical coding guide like Supercoder!
About the Author
We provide you simple, instant connection to official code descriptors & guidelines and other tools for 2010 CPT code, HCPCS lookup that help coders and billers to excel in the work they do every day.
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