Part B Insider (Multispecialty) Coding Alert

Published on Fri Sep 15, 2006 PDF

Follow up with problem doctors every few months

Sometimes you can have a problem with your evaluation & management billing and not realize it--especially if you-re letting your physicians choose the visit levels for themselves.

A regular audit of E/M charts is the best way to detect problems that sneak under the radar, say experts. But how often should you perform such an audit, and how should you select charts to audit? Here's what the experts say.

Frequency: Experts disagree on how many charts you should pull for an E/M audit, or how often you should perform one. The good news is that most experts don't think audits need to be huge.

A good standard is 10 charts per provider, every six months to a year, says Quinten Buechner, consultant with ProActive Consultants in Cumberland, WI. You should try to select charts that represent the codes your physician bills most often, so if your doctor does a lot of consults the charts should include some consults.

Or you could audit two charts per doctor per quarter and choose the charts at random, says Marti Geron, coding and reimbursement manager at University of Texas Southwestern in Dallas. Try not to pick the same codes that you audited the previous time, she adds.

Smart idea: Some practices perform a weekly chart audit. -It keeps people fresh and keeps the doctors on their toes,- says Terry Civitella with Sally Balin Medical Center in Media, PA. Civitella chooses one doctor per week, and picks one random date from the past three-month period, then pulls 10 E/M charts from that date.

Troubleshooting: If the charts pass, you-re home free, says Buechner. If not, then pull another 20 charts similar to the first 10 and see if you keep finding the problem. If so, then it's time to sit down and educate your physician.

If a doctor seems to be having a particular problem with one E/M code, then Civitella recommends pulling three or four charts containing that code at the next weekly audit. Don't focus so much on one E/M level that your doctor starts neglecting documentation for other levels, Civitella warns.

-The doctors feel their coding skills have been validated after we have reviewed their charts,- Civitella says. -If we find any problems, they are anxious to know about it and learn how they can improve.-

Baseline: Before you start auditing E/M charts, you should consider doing a -baseline,- where you audit more charts to look for problem areas that you should focus on in future, say experts.

A good rule of thumb is to audit 50, 100 or 150 charts as a baseline, depending on the size of the practice, says Katie Cianciolo, a Wisconsin-based coding consultant. At a minimum, you should audit at least 10 charts per physician as a baseline, she says.

Your baseline should be a random sampling of all E/M services, meaning every tenth patient who received a particular E/M level, says Catherine Brink, president of Healthcare Resource Management in Spring Lake, NJ. She recommends at least six dates of service per doctor per E/M code, or about 10 dates of service total.

You should consider following up with your doctors 60 to 90 days later about any problems you find during a baseline audit, Brink says. Keep following up until your doctor gets 100 percent correct, and then your doctor can wait six months until the next audit.

New providers: Consider auditing new providers at least three times during their first year, says Lisa Huosseiny, a coder in Austin, TX.

Benchmarks: You can benchmark your physicians- use of particular E/M levels against national or regional standards to see if they-re billing a particular level more than usual, says Huosseiny.

Real time: Try auditing recent charts first thing in the morning, and then discussing with your doctor over lunch, says Huosseiny. That way, the doctor will still remember those patients.

Software: Consider using software, such as Intelicode, to add consistency to your auditing process, advises Cianciolo.

Editor's Note: For more guidance on auditing your practice for coding errors, see this week's Coding Coach.