Wiki Provider Audits and Education Methodologies

[cacostin]

Requesting help from other organizations that perform physician audits. Looking for some answers to the following questions.

1) What does your audit/review process look like for providers in your organization?
a. How do you select providers for review?
b. How many patients records do you sample?
c. Do you perform audits on a pre-billing or post billing review?

2) How are Providers educated in coding/billing/documentation in your organization
a. Is education only provided following a review? If so, is it verbal or some other method?
b. Are education sessions conducted for individuals who might be a higher risk? Are these one on one or by group (i.e., provide type)?
c. How often is formal education provided (i.e., annually)?

3) How does your organization hold provider accountable if they do NOT perform satisfactorily in coding audits (i.e., withhold salary, fines, dismissal, etc.)?

Thanks fellow coder friends.

 

[em2177]

1) What does your audit/review process look like for providers in your organization?
a. How do you select providers for review? All are audited
b. How many patients records do you sample? 20
c. Do you perform audits on a pre-billing or post billing review? Post

2) How are Providers educated in coding/billing/documentation in your organization
a. Is education only provided following a review? If so, is it verbal or some other method? Yes, provider groups and one on one
b. Are education sessions conducted for individuals who might be a higher risk? Are these one on one or by group (i.e., provide type)? All
c. How often is formal education provided (i.e., annually)? As needed basis

3) How does your organization hold provider accountable if they do NOT perform satisfactorily in coding audits (i.e., withhold salary, fines, dismissal, etc.)? Operational discretion