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Thread: Ob/gyn Audit

  1. #1

    Exclamation Ob/gyn Audit

    AAPC: Back to School
    Help! I am new to OB/GYN and my MD's want me to do a practice audit, which would include chart audits, to help them understand why they are losing $$ Do any of you have templates, guidelines-I am appreciative for anything. I'm starting from scratch...

  2. #2
    Join Date
    Apr 2007
    Bay City


    Try going to your local medicare carrier for your ob guidlines. I would also refer to my CPT guidlines. I'm sorry I cannot help you out with any templates but try googling for ob chart audit templates.
    Last edited by mstenochs; 07-09-2008 at 03:00 PM. Reason: spelling error

  3. #3


    If your doctor is losing money is it because the number of patients changed? I would start by comparing the type of insurances your recent patient have. Did you see more Medicaid patients this year compared to last year? Keep a better check on the prgoress of your patients... with pateints that have insurances using global codes if another doctor delivered your patient are you going back and billing the visits? this is where I would start.

  4. #4


    When you say'refer to my CPT guidelines' are you referring to the guidelines in the 2008 CPT book or another resource? Thanks!

  5. #5


    Thank you so much for that advise. I will look into those:
    1) # of patients changed fom one year to the next
    2) Increase in Mediciad patients?
    3) Global OB patients billed out per visit if not delivered by us

    Please let me know in this speciality if there are any other areas that come to mind that comparing yearly P/L's won't show me. Thanks!!!!

  6. #6
    Join Date
    Apr 2007
    Charleston, South Carolina


    A couple of other things to check:

    Were balances written off along with allowed adjustments? Legitimate balances (pt's portion, deductibles, copays, etc) not collected can make a hugh difference also.

    What is your payor mix? Did it change recently (due to a major employer changing insurances is one example).

    Also, you want to make sure the practice is collecting all copay and pt responsibility up front that you can, saves a lot of postage and collection costs. Little things can have a tremendous effect on A/R.

    Good luck,

  7. #7
    Join Date
    Apr 2007
    Southern IL Carbondale

    Default OB Audit

    I went to the ACOG web site and then went to coding. They have developed 2 tools one for 95 and one for 97 Medicare guidelines. I would take a look at there [url]http://www.acog.org/departments/dept_notice.cfm?recno=6&bulletin=157

  8. #8
    Join Date
    Apr 2007
    Kansas City, MO


    Another thing you will need to do is look at the contracts your physicians signed with each Insurance and understand their policies regarding OB. When you start researching this you will see that each carrier has specific ways they want certain scenarios billed. Some of the larger carriers have their policies posted on their websites for easy access.
    Angela Jordan, CPC
    AAPC of Kansas City
    National Advisory Board Representative Region 5

    Medical Revenue $olutions
    Senior Managing Consultant


  9. #9


    Lisa, I have some audit forms specific to OB-GYN if they will help - I do not have a scanner but would be happy to fax them to you if you want. Just furnish the fax number. Good luck!

  10. #10


    Lana- that would be so helpful- thank you!!! My fax # is (423) 990-2496

    Thank you!

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