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external audit question

  1. #1
    Default external audit question
    Medical Coding Books
    My name is Melissa and I am a Compliance and Coding specialist in Salem, OR. I am trying to reach out to other compliance specialists/auditors to reveal an industry standard regarding external audits.

    We are a professional billing organization and are responsible for coding multispecialties for professional charges. We are interested in finding out how often audits are being done by other similar groups, specifically external audits. Is there a compliance plan for professional coders in your organization to be audited on a yearly/biyearly schedule?

    Our practice currently is biannual external audits for our coders and internal audits on coders as needed. We are looking to see if possibly yearly external audits are enough as we have ongoing internal audits if we find a problem.

    Thank you for your help,
    Melissa Tescher, CPC, CPMA, CEMC Compliance and Coding Specialist
    Willamette Valley Professional Services member National Advisory Board 2013-2015

  2. #2
    I am an external auditor and the number I recommend usually depends on what I find on the initial audit. If the error rate is low and there are no major issues found, yearly external audits should be sufficient. If I find a high error rate or major issues, I will recommend either a biannual audit or quarterly prospective audits.

    For major issues, I find that the quarterly prospective audits work well because they provide physician education before the claim is sent instead of after.

  3. #3
    Thanks for your reply. We actually internally audit our providers on a biannual basis, (and have externals done for the ones that really need help) but we are trying to see if its necessary to have the coders audited by an external source biannually or if we are ok on an annual basis.
    Melissa Tescher, CPC, CPMA, CEMC Compliance and Coding Specialist
    Willamette Valley Professional Services member National Advisory Board 2013-2015

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