Audit Education – Who is Teaching Whom?

By Jaci Johnson Kipreos, CPC, CPMA, CEMC, COC, CPCI
President Elect AAPC NAB 2013 – 2015
Welcome to my first monthly blog focusing on auditing. Here we will talk about and consider all aspects of an audit. Whether it is discussing one of the steps of an audit, what to audit, or what is frustrating when conducting an audit – it will be found here each month. Your comments are appreciated as well as your feedback. If a topic creates a difference in opinion that will be great as well and we may all learn something from the experience. Let’s start with education discussed at the end of an audit.
Part of any audit is also education, not just a report with findings. I just finished a focused audit for a provider who was heavily coding 99232 for all subsequent hospital visits. Based on documentation, some of the visits billed as a level 2 should have been a level 1 and some satisfied the requirements for a level 3. I spent a lot of time explaining the importance of medical complexity. I felt the provider had a firm understanding and was feeling very good about our conversation. As I was about to leave and was wrapping up our discussion the provider made the comment that he would not be billing any 99231s or 99233s. I questioned him as to what the rationale might be considering we had just spent 45 minutes in discussion and reviewing examples. His conclusion was based on the fact that he felt the reimbursement for a level one was too low and not worth the effort to drop a claim. The reason for not billing a 99233 was based on the theory that the insurance companies do not want to see a level 3 and he would be at risk for an audit or a pre-payment review. I countered with the risk of audit based on not having any bell curve and billing all the same level of service. I have this same conversation so many times and find it quite frustrating. Why would you not want to get paid for the work that was rendered? Or is the provider correct in the logic and does it just not matter? Sometimes I am just not sure who is getting educated. What do you think? How do you educate on changing a way of thinking?

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Jaci Kipreos

Jaci Kipreos, CPC, COC, CDEO, CPMA, CRC, CPC-I, CEMC, has been in the field of medical coding and auditing for over 30 years and received a Bachelor of Science degree in finance from Virginia Tech. She has worked in a variety of practice settings and has expertise in coding for family practice, urgent care, obstetrics and gynecology, general surgery, and Medicare’s teaching physician guidelines, with an emphasis on compliance with evaluation and management guidelines. Kipreos has been an instructor for various AAPC workshops for the past 10 years and is a frequent speaker at AAPC’s national and regional HEALTHCON conferences. She has also provided presentations for the American Association of Nurse Practitioners state event in Virginia and the national event for the American Association of Medical Assistants. Kipreos is a past president of the Richmond, Virginia and Charlottesville, Virginia local chapters, and served as president of AAPC’s National Advisory Board from 2015 to 2018.

Latest posts by Jaci Kipreos (see all)

• Is Becoming an Auditor In Your Future? - October 3, 2022
• Changes in Healthcare Come Each Year and It's a Good Thing - June 30, 2016
• What's the Effect? Medical Auditors Ask Questions. - May 17, 2016