Wednesday, September 11, 2013

Chart Audit: Is Your Practice Billing What It Should?

Medical Coding Audits
Missed lab charges, understated injection units, and missed office surgeries can subtract tens of thousands of revenue dollars from your income every year. Conducting an internal chart audit can help you discover and correct flaws in your system that allow costly omissions like these. You don’t have to spend thousands of dollars on an outside consultant to perform an effective review. Using an orderly procedure and recording your findings in a spreadsheet to track anomalies, you can quickly see:


  • Charge capture effectiveness for all your services;
  • Claims follow-up effectiveness;
  • Accuracy and thoroughness in code selection, charge entry, claim submission, and payment and adjustment processing; and
  • Patterns and flaws in your systems at the root of these problems.
The term “audit” can chill a physician or a practice manager to the bone. Whether conducted by the IRS, an accountant, or a healthcare payor, it conjures up images of being scrutinized, reprimanded, and penalized. Avoiding an expensive audit outcome is only one reason—albeit a good one—to have a thorough compliance plan that includes periodic internal audits. Even if you never have to return over payments or pay a fine, effective internal reviews play a key role in maximizing your entire revenue-cycle performance. Few small and mid-sized group practices invest adequate resources in creating and maintaining good compliance controls. Betsy Nicoletti, Founder of www.codapedia.com and a coding an compliance consultant based in Vermont, describes four often-neglected elements that will bring sizable returns on your investment:
  1. Staff resources. You might be amazed to discover how many practices skimp on maintaining software and hardcopy references and tools for staffers with coding and billing responsibilities. 
  2. Make sure you purchase the current year’s CPT-4 and ICD-9-CM manuals, supplemented by specialty-specific training manuals and coding guides. Subscribe to one or two reputable newsletters to keep up with the latest news between annual coding updates. Share the free website www.codapedia.com with your staff members.
  3. Staff training. Using manuals and guides will take you only so far. Sending key personnel to coding and billing seminars provides opportunities to network with other practices and benefit from others’ experiences. Your staff will gain new confidence and establish new relationships that can serve your practice for years to come. Coders often call or e-mail one another as they puzzle over tricky billing scenarios.
  4. Physician training. Even if you have the President of the AAPC working for you, he or she relies on your notes, dictation, or EMR input to choose or review the codes that drive your revenue engine. The more thoroughly the physician understands the relationships between code choices and reimbursement, the better your chances for maximizing reimbursement.
  5. Have each provider attend a coding seminar presented by his or her specialty society at least once every two years.
  6. Employing a specialist. Whether you hire a certified coder or “grow your own” by sponsoring a trusted employee, your practice will very likely enjoy improved revenues that more than cover the higher salary and benefits — but only if you use him or her effectively. A certified coder must be regarded as a true expert with authority to train and correct others in your billing department. In fact, you must make sure that physicians treat your coder as an authority who need not be intimidated by the medical professionals. If you feel you really can’t afford to invest in these kinds of resources, consider partnering with colleagues. Perhaps you and another practice could get together to hire a coder to split his or her time between the offices. Unless the coder prefers working as an independent contractor, one practice would serve as the primary employer while the other (or others) reimburse it for their share of the time.
Whatever works best for your particular situation, just remember: Good effective coding and billing is fuel that drives your revenue cycle engine. Invest in “premium grade.”
If you enjoy reading the blog entries in "Solving Problems in the Medical Practice" you may want to check out all the great products at Greenbranch Publishing.

photo credit: joebeone via photopin cc