What we are currently doing is much the same. Providers are all audited on a scheduled basis, and all charges submitted (E/M, procedures, labs, etc) in that providers name/number are reviewed. We also look for missed charges. Sometimes we find things like a flu shot that the nurse recorded in the chart, but billed only the vaccine and not the administration. Or mention in the chart that U/A was performed, but it was not billed. Or, the person keying the charges enters the incorrect provider number because she transposed it or something. The doctor is usually unaware of these errors. We do make note of the missed opportunities to bill and bring these to his attention, but we do not count it against his score at all since there is no compliance risk there. Likewise, we note the other incidences by the nurse or billing staff as administrative errors and also do not count those against the provider. We do, however, take the action of notifying the clinic's Practice Director and having them see that the incorrect billing is backed out, refunded if appropriate, and rekeyed since it may still essentially be a "false claim" and the provider is made aware of these. So, overall, the only things we truly "ding" the provider for is E/M's that are over/under coded, incorrect catagory (new patient vs. consult), procedures billed for but not adequately documented, bundling issues (E/M not supported by documentation reported with a scheduled minor procedure) etc, etc. For the scoring, we figure it both with and without the administrative errors. The score is sometimes very close, but it at least makes the provider feel a little better in that they are not held responsible or "punished" for someone elses mistakes. It also helps us identify clinics or practices that may have staff doing sloppy work that needs to be addressed.
Does this help ??
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