Monthly Archives: February 2014

Conducting an internal chart audit require team effort to plan, execute and analyze the results.  You will get far more out of the audit by involving team members from different departments and presenting it as an exciting time to learn more about the inner works of the clinic visit and their implications on practice finances.  A team of five is perfect; a receptionist or scheduler, a biller, a nurse or medical assistant, a medical records or data entry person and a physician or other provider. Begin by gathering five random patient records per each provider and selecting one date of service for each patient; the date of service should be three to six months prior.  This allows adequate time for insurance processing and receipt of third party payment on the records being reviewed.  Staff should break into teams of two – preferably one administrative staff and one clinical staff person.  Each team should review a minimum of five charts and document discrepancies.  When the review is completed, they should analyze the results to determine if the same errors are recurring or if there are different areas of the practice or service where problems occur.  They should then calculate the potential cost of the errors over a twelve month period.  The next step is to make a recommendation on how to approach correcting the deficiencies for long term benefit. Common problems detected: Discrepancy in evaluation and management level of service (E&M code) Wrong diagnosis Missing dictation Incomplete charge slip Missed office charges:  Procedures, lab, x-ray Missed hospital charges:  ER visits, consultations Insurance write offs taken that are not justified  (payment overlooked or discounted by payer) Patient balances written off on Medicare patients All of these problems have the potential to both cost your practice money in the short term (e.g., by causing denials or delays or down-coding) or in the long term by triggering an audit by Medicare or a private payer.  By conducting your own internal audit, not only will your staff learn what kinds of mistakes you've unwittingly been making (and be able to correct them), everyone will understand

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. 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. 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. 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