Practice Management Alert

Hire the Right Auditor

Published on Sat Mar 01, 2003

Billing and coding audits are your office's report card, which is why you want a fair and informed auditor. A good auditor will point out instances of noncompliance and may find billing problems that decrease deserved reimbursement.

Here's how to pick an auditor that will be honest and helpful in assessing your practice.

Internal Versus External Auditor

When hiring an auditor, you first have to decide whether you want an internal or external auditor, that is, one of your employees or someone outside the practice.

If you hire an internal auditor, you can have more claims reviewed, says Betsy Nicoletti, CPC, a consultant with Helms & Company, a physician practice management company in Concord, N.H. An in-house auditor is less expensive, so you can get more claims reviewed for your money. This advantage, however, may be offset by the costs it takes to train your employee. Learning to audit appropriately "is not rocket science" but is complicated enough that you have to send your employee away for training, she adds. But other experts encourage practices to look outside the office to get an objective and professional review.

Internal auditors quite often look only at one selection of codes during a review, not the entire picture, says Jan Rasmussen, CPC, president of the Eau Claire, Wis.-based Professional Coding Solutions.

An outside auditor can give you a fresh perspective on your billing and coding habits, and pool experience from various cases to give a well-rounded, objective review.

If you hire an outside auditor, you should ask a list of baseline questions. Ask specifically about the candidate's experience, and discuss details of past audits.Find out as much as you can about his credentials and experience in the field, Rasmussen recommends.

Other Hiring Tips

Whether you're hiring an internal or external auditor, follow Nicoletti's tips for securing top-notch reviews.

Hire an auditor who:

knows your specialty.

commands the respect and has the confidence of your physicians. You want an auditor whom you can trust to provide informed and objective reviews, and education for physicians and staff if needed.

provides consistent advice from year to year. At the same time, you need an auditor who's on top of recent regulations and guidelines and will change advice to fit these updates.
What Your Outside Auditor Needs to Know

If you hire an outside auditor, that reviewer needs to know certain details about your office and practice before the audit begins.

More likely than not, your auditor will ask you plenty of necessary questions, but here's a list of details you should cover, just in case a topic slides by. Some of the details may be useful for internal auditors too. These tips are provided by Rasmussen.

your practice's specialty (-ies)

the type of facility (e.g., rural health clinic, teaching facility)

the providers included in the audit

who in the practice supplies the codes (physicians, coders)

who appends modifiers

the training level of the responsible personnel

the number of certified coders

the availability of current coding resources (i.e., newsletters)

the EOB problem areas

billing and coding problems the staff is aware of

how physicians feel about documentation, coding processing and fees (i.e., is there controversy about these topics?)

whether physicians and administration agree with your compliance plan and how they respond to audits