Medicare Compliance & Reimbursement

Whether you code for a Part B practice or a large hospital system, you’ll need to understand how to conduct a self-audit. There are a few simple steps to add to your checklist that will help keep you on the right track.

If you don’t know quite where to begin when you perform your first self-audit, keep this handy reference as a guide to remind you what types of questions you should be asking yourself. For each chart, make sure you can answer the following questions, and you’ll know you’ve done a thorough job:

Audit Checklist

• Does the documentation in the encounter support the level of E/M service that the physician billed?
• Does the documentation in the encounter support the codes for non-E/M services, such as procedures or diagnostic tests, that the physician billed?
• Did the physician use modifiers correctly?
• Does the physician’s documentation support the ICD-10 codes the practice reported?
• Did the providers date all entries?
• Is the place of service (POS) code correct?
• Is the encounter documentation legible and are the reports signed in accordance with Medicare requirements?
• Are the names and identification numbers of the patient and provider on each page of the claim form?
• Does the patient identification sheet include completed biographical data, including the patient’s address, employer, home and work telephone numbers, and marital status?