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office audit, pls help?

  1. #1
    Default office audit, pls help?
    Medical Coding Books
    i'm going to do conduct a large MD practice internal audit. just to see if we billed correctly and received payments due.

    any recommendations on what i need (e.g all claims that went out, remittance, posting of payments?)

    advice appreciated
    Laurie

  2. Default Mc audit
    Laurie,

    I just finished this for the DME I work for and I must say GOOD LUCK!!! It's a very daunting task. If you can I would start by printing up an list of all your current pt's who have medicare as a primary insurance. Then go through the list very carefully and look at all the open invoices that you are waiting for mc payments on. If you have any denials I would flag that pt's chart and look at the past 6 months of billing to see if they were done correctly.

    Then move onto the next largest insurance you take and do the same thing as I mentioned above. But be warned *** It is going to be at least a 3 person job and take a lot of time.

    Brandy

  3. #3
    Default
    thank you.
    Did I ask for for the correct documents?

    All patients seen for the month i'm auditing
    All bills that went out to ins. co.
    all remittances
    all denials.

    Do you think I will find claims that were not paid? I'm actually auditing a office that we just took over.

    I so appreciate your help!
    Laurie
    Laurie

  4. #4
    Default
    Quote Originally Posted by NJcoder View Post
    thank you.
    Did I ask for for the correct documents?

    All patients seen for the month i'm auditing
    All bills that went out to ins. co.
    all remittances
    all denials.

    Do you think I will find claims that were not paid? I'm actually auditing a office that we just took over.

    I so appreciate your help!
    Laurie
    Oh, no! You've got your work cut out for you, that's for sure...You mean to tell me that no one follows up on claims after they're sent, to make sure they get paid? I'd hate to imagine how much money's being lost, there. I'd be extremely surprised if you don't find any outstanding money...

    What are you auditing, exactly? Billing accuracy? Documentation accuracy? Everything?

    For documentation audits (retrospective):
    Start by pulling 10-15 charts, and code them. Then pull the billing records to see how it was billed, and if it paid. You may need to submit corrections/refunds. For the first couple that you do, I'd suggest only pulling encounters from the past 90 days, so that you can make corrections within your filing deadlines.

    You could also do prospective, which is basically the same thing, except that you hold the claims until the audit is complete. That way, you can make necessary changes before the payors ever see the charges. I would only recommend prospective for really small practices, or as a remedial measure for providers who have had bad audit scores in the past. Otherwise, it's really not practical.

    For billing/payment audits, you should review all of the claims submitted during a certain time frame (30 days, 60 days, etc.) - separate them by payor. Calculate the percentage of denied claims based on reasons (modifier, patient benefits, diagnosis, etc.), so you can have an idea of what mistakes are being made, and how many could have been prevented.

    If you don't already have it, you might suggest that the doctor invest in a billing system that can keep track of all of that for you. We use GroupCast Centricity by GE, and we have another program called Anodyne Analytics that works with it. You can run basically any kind of report you can dream up, and it has task queues for people to follow up on outstanding/denied claims. I'm sure there are other great software manufacturers out there for that kind of stuff; you'd just have to research it to find the one that would work best at your practice. It's worth the expense - trust me. Good luck!

  5. #5
    Default
    Since April of this year there haven't been any followups. I am auditing to see any unpaid claims.

    I actually just bought and listened to "Internal Audit" from on demand through AAPC, it was good, but not what I was looking for. Can you recommend a webinar, website or anything else that concentrates on auditing claims?

    Any particular tools needed for this type of audit?

    Thanks for all your useful advice.
    Laurie

  6. #6
    Default
    Quote Originally Posted by NJcoder View Post
    Since April of this year there haven't been any followups. I am auditing to see any unpaid claims.

    I actually just bought and listened to "Internal Audit" from on demand through AAPC, it was good, but not what I was looking for. Can you recommend a webinar, website or anything else that concentrates on auditing claims?

    Any particular tools needed for this type of audit?

    Thanks for all your useful advice.
    What's your email? I'll throw something together for you...

  7. #7
    Default
    I have a spreadsheet that may be useful to you, but I can't attach it here. If you want it, let me know, and I can email it to you. It's got all of the info I could think of that you might need to analyze claim/billing accuracy.

  8. #8
    Default
    Brandi I have used so many of your postings as learning tools it would almost be considered a crime!
    I am in the same predicament regarding auditing. I can do the audit but I can't figure out how to document it. Any chance I could get a copy of your spreadsheet? I hope a don't start a "me too" epidemic! My email address is shaydysch@cvikota.com
    Thanks, Sue

  9. #9
    Default
    Quote Originally Posted by susiekay View Post
    Brandi I have used so many of your postings as learning tools it would almost be considered a crime!
    I am in the same predicament regarding auditing. I can do the audit but I can't figure out how to document it. Any chance I could get a copy of your spreadsheet? I hope a don't start a "me too" epidemic! My email address is shaydysch@cvikota.com
    Thanks, Sue


    Provider audit or billing audit? I'll just send you both, and you can see which one would work better for what you're doing...

  10. Default
    Brandi, you're a life saver. I appreciate this. My email is laurieny2002@yahoo.com
    Laurie

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