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Physician Auditing

  1. Default Physician Auditing
    Medical Coding Books
    I'm new to physician auditing/education. Does anyone have any suggestions on how to set aside nerves and not be intimidated? Do you know of any articles to check out on physician educator/auditing?

  2. #2
    Default Physician Auditing / Education
    Auditing a physician practice can be intimidating as some providers are receptive and others are not. The success lies in your ability to build a high level of trust and credibility within the practice and amongst the physicians you are auditing.

    While providing education and training to physicians whether it is one on one or in a group you must remain focused, confident and display a positive attitude. Most providers want to learn how to accurately choose the level of service based on their supporting documentation.

    The method in which you display your audit results is equally important and should be visually easy for the physician to review and interpret. Provide as many educational tools as possible and make it clear that the audit is being done for educational purposes only and not meant to be punitive.

    The longer you audit and the more feedback you recieve the more comfortable you will feel.

    Hope this helps,
    Maria A. Candia CPC

  3. #3
    Stuart, FL
    I definetely recommend studying the 95 and 97 guidelines as well as taking a look many of the CMS reference tools.

  4. Thumbs up Relief
    Thank you this information helps a great deal!

  5. #5
    i E&M audit 40+ docs. when i first started i was a nervous wreck.
    i did roll play with my supervisor and had her act like a mean dr with lots of questions and disagree with my assessment. she then gave me suggestions and ways to improve or handle a tough dr. my supervisor (was great) she also attended the first couple of reviews. seh was as asset since i did not deal with the reimbursemnt side of things only the auditing. i do agree with being possitive,well informed, aand have supporting documentation. and if questions come up that you are not completely sure how to answer, inform the dr you will do more research and get back with them. then you are not providing wrong info and you are showing them that you want to make sure the info you provide them is correct and accurate. Just get back with them though. good luck, the more you do the better your routine will become.

  6. #6
    Default Putting Nerves Aside...
    I've been auditing for about 2 years and the best advice I can give is (1) be confident in what you know, (2) be willing to admit what you don't know and research to find the answer, and (3) remember you are there to educate the provider (so it's about them and not you - this helps me focus on what I am saying and not my nerves). The longer you do it the easier it is.
    2012-2013, 2016 President, AAPC Indianapolis Indiana Chapter
    2013-2015 AAPC National Advisory Board Member

  7. #7
    Talking Physician auditing
    I have been auditing physician records for years and I have found things by trial and error which work best. Never give an opinion, always provide authorative documentation; ie: CMS, rules/guidelines from code books. Physicians do not want your opinion, they want authoriative sources. I always remember they put their pants on one leg at a time just like me. I refuse to be intimidated, they can rant and rave, I stay calm, cool and professional and when they are done, I will address the issue's they raised and provide authoriative documentation so there is no misuderstanding. I do not make the rules, I am just the bearer of bad news...(sometimes). This has worked for me, and I have had some extremely difficult physicians to deal with. My job is to help them with rules and guidelines, stay in compliance, and make sure the service is documented appropriately. I always let the physician know I am on their side, and I do not make the rules. I play by the rules, and the physician needs to become educated to maximize his reimbursement thru proper documentation. I explain there are no short cuts, my job is to provide education and I have many audit tools I use to document why his/her service did not meet the level of service they chose. I never show fear...this gives them power over you and they will try to intimidate you into agreeing with them even when you know its wrong. Above all else, stay professional, and if necessary I go back to my desk and research the item in question, and then provide them with the documentation.

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