Practice Management Alert

Consider nine criteria when you sit down with your case files.

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:

• Does the documentation support the level of service billed?
• Does the documentation support the CPT® and/or HCPCS codes billed?
• If the physician coded a consult, does documentation of a request from a third party exist in the chart? Does the chart contain a written consult report back to the third party?
• Did the physician use modifiers correctly?
• Does the documentation support the ICD-9 codes the practice reported?
• Did the physicians sign and date all entries?
• Is the chart legible?
• Is the name and identification number of the patient and provider on each page of the medical record and 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?