Practice Management Alert

Experts: Annual self-audits are a good idea.

In the previous edition of Practice Management Alert, we focused on why self-audits should be an important part of any medical practice’s schedule. Not only can self-audits clear up coding and billing issues before payers take notice, but these audits can also help you sort out any lost revenue issues your practice might be experiencing.

Take this advice on the whos and whens of self-audits, and see your practice vault past any potential compliance hurdles.

Perform Self-Audits At Least Annually

Expert opinions vary on how often you should perform a self-audit; your self-audit frequency will depend on practice resources and other mitigating factors. No matter the practice’s individual situation, however, experts recommend that you perform audits once a year, at minimum, to ensure compliance.

Although you should perform audits at least yearly, “you may want to do it more often,” says Suzan (Berman) Hauptman, MPM, CPC, CEMC, CEDC, senior principal of ACE Med, a medical auditing, coding and education organization in Pittsburgh, Pa. The number of self-audits could depend on anything anything from practice size to the introduction of new treatments. And it needn’t be permanent; you might want to conduct self-audits more regularly for a brief period, and then return to a six-month or one-year self-audit gap.

Examples: Let’s say your practice just started providing a new procedure, or offering a new service. “It’s important to audit that service at the beginning, perhaps every 90 days for a period of time,” Hauptman says.

Or if you hire a new physician, the practice should audit him “after 30 days, and then again after about 90 or 120,” she advises.

If your practice has the infrastructure, it might conduct self-audits by claim, according to Steven M. Verno, CMBSI, CHCSI, CMSCS, CEMCS, CPM-MCS, CHM, SSDD, a coding, billing and practice management consultant in central Florida. He offers the example of a practice that “performed an audit weekly, and brought issues to the managers and provider at every Friday meeting.”

Best bet: Tailor your self-audits to your practice’s needs. Also, ask coding and billing managers to keep you posted about any changes to coding/billing practices or procedures. That way, you can introduce temporary self-audits on a need-to-have basis.

Consider Coders First-Line Self-Audit Conductors

To flag down any potential compliance issues, everyone involved in coding and billing should be on alert for potential problems, Verno says. “Every employee should be tasked to look for red flags to indicate a potential problem. Problems should be brought to the attention of a designated manager,” he says. If you want to go this route, be sure to appoint a compliance manager who is charged with investigating reports of “red flags.” 

When it comes down to who is performing regular the self-audits, options vary. The coder could perform the self-audit “if she isn’t the one that codes the services,” Hauptman says. But use caution, because “you don’t want to have someone audit their own work,” she adds.

If you don’t have enough coders that you can successfully have all the work audited in-house, Hauptman recommends that you hire an outside auditor, “or have someone in the office who is aware of coding” perform the self-audit.

Listen to the Experts: Self-Audits Well Worth the Effort

No matter which method you choose, your practice should have a self-audit schedule that includes deadlines for each audit and lists parties responsible for the audits.

Even though they might take some time, self-audits can only help the practice. Self-audit carefully, and you can launch a preemptive strike on coding and billing problems — before they become the stuff of nightmares.

Remember, “it is easier to fix a drip before it becomes a raging torrent,” reminds Verno.