Medicare Compliance & Reimbursement

Notice the trouble signs before they turn into disasters. When you're auditing your charts, will you know how to recognize the signs of a major problem? Although you might find your coding practices routine, auditors might see them as red flags. "It is difficult to say what carriers are deeming to be 'red flags' in determining which services to audit," says Devona Slater, CHC, CMCP, president and compliance auditor with ACE Auditors in Leawood, Kan. However, "it is true that many sophisticated tools are available and physician profiling does occur with many payers." Read on to learn about seven potential red flags that you might find taking place at your practice. 1) The same diagnosis code for every visit. One consultant recalls a practice which used the same ICD-9 code for foot pain with every visit. On average, it was billing $600 per visit, and some visits were as high [...]