Practice Management Alert
Easily Evaluate Your Billing Procedures With Internal Audits
Tip: Begin with a baseline audit and then make changes before outside auditors come knocking Would you pass an audit if a payer auditor showed up at your practice door? You should be using internal chart reviews to evaluate your practice's compliance and billing processes -- before someone else does. Performing internal audits doesn't have to be painful and time consuming. Take a look at these expert tips and formulate your own internal audit system. Reap the Benefits of Internal Reviews Performing internal audits can help you ensure billing and coding compliance and may also help you find money you-ve been leaving on the table, says Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley and Associates in Clearwater, Fla. "Not only is this important -- it is crucial to a practice's success," adds Susan Garrison, PCS, FCS, CCS-P, CHC, CPC, CPC-H, CPAR, executive vice president of Magnus Confidential Inc. in Atlanta. "Finding problems early helps alleviate risk. Additionally, internal audits might point out when you need to bring someone from the outside in to help." Audits will also uncover inconsistencies in documentation and coding so you can focus your staff education. "Maybe something conveyed was misunderstood, or confusing, and that will come out in the audits," says Suzan Hvizdash, CPC, CPC-E/M, CPC-EDS, medical auditor for University of Pittsburgh Physicians. "Without regular internal audits you would have no idea how the practice is doing with regard to its compliance of the regulations and guidelines." Tip: Refer to these internal audits as reviews, Hvizdash suggests. "That way they are not as threatening as the word -audit- may convey," she explains. Mac agrees: "An audit gives the essence of seeking mistakes and problems that require recoupment, so I call them reviews," she says. "Reviews are more judgmentally selected encounters based on coding patterns and problematic areas and are designed to get a statistically valid sample." Start With a Baseline Evaluation You want to begin your audit efforts by performing a baseline audit -- the first comprehensive audit your practice undergoes. Then you can decide how often you will perform internal audits each year. Why? With the information gleaned from a baseline audit, you-ll be able to streamline future auditing efforts and focus on the most important areas to your insurers. Your goal is to get each provider and each biller as close to 100 percent compliance and accuracy as possible. The baseline will help you decide how frequently you need to perform future audits and also help you determine the areas for improvement that your practice should focus on between audits to increase the compliance percentages. Going forward: How often you perform internal reviews after the baseline audit depends on several factors, including your time and staff resources, the baseline audit's results and your practice's size . Best bet: Plan to perform an internal audit at least once per year and more often if you uncover low compliance rates, Hvizdash suggests. "If the size of the practice or auditing staff permits, every six months or quarterly could certainly be advantageous," she adds. Follow a Checklist When Preparing Your first step in the auditing process is to narrow the parameters of your audit. You should answer the following questions before you start: - What is the focus of the audit? You need to know exactly what you want to accomplish with your internal audit. - What will the audit's scope be? Consider which providers, services, date ranges and payers your audit will address. Look at areas such as incident-to billing, modifier use, code edit unbundling and consultations. - How will you select charts? Will you fix this process for each provider, or will you randomize the chart selection? You should select a minimum of 20 charts per provider for your review, Mac says. That chart selection should include a variety of types of services, including E/M services, consultations, hospital services and surgical procedures. - What documentation will you review? Pull charts and organize supporting documentation, such as a printout of physician notes, account billing history, CMS-1500 forms and explanations of benefits (EOBs) to review during your audit. "If the practice deter-mines it is meeting all the guidelines and that it's doing everything according to what the payers require, the next step is to determine that there is supporting documentation," Mac says. - Where do denials fit in your review?
During an audit, or even during a separate billing review, you should be reviewing any denials you get. "If you do a review and everything seems right in your billing, but the claims are still being denied, you need to investigate that," Mac explains.
Practice Management Alert
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