Self-Audits – Crucial for Your Medical Practice

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Self-Audits Crucial for Your Medical
Practice
Auditing is important to evaluate the physician
processes to make sure their compliance plan is
operating correctly and to identify any
inappropriate documentation, coding,
and/or billing practices. One of the most
important reasons for auditing is to identify any
potential areas of concern that could put the
physician or practice at risk for audits. OIG
states self-audits can be used to determine bills
are accurately coded and accurately reflect the
services provided  documentation is being
completed and correct services or items provided
are reasonable and necessary, and any incentives
for unnecessary services exist. Annual
self-audits are a good idea. Not only can
self-audits clear upcoding and billing issues
before payers take notice, but these audits can
also help you sort out any lost revenue issues
your practice might be experiencing. The number
of self-audits could depend on anything from
practice size to the introduction of new
treatments. And it neednt be permanent, you
might want to conduct self-audits more regularly
for a brief period, and then return to a
six-month or one-year self-audit gap. Lets say
your practice just started providing a new
procedure or it is offering a new service. Its
important to audit the new service at the
beginning, perhaps every 90 days for a period of
time. Or if you hire a new physician, the
practice should audit after 30 days and then
again after 90 or 120. If a practice performs an
audited weekly, the findings and issues can then
be brought to the managers and provider at weekly
meetings.
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Self-Audits Crucial for Your Medical
Practice

• OIG recommends two types of reviews
• Standards and procedures review - Are the
  standards current, complete, or need to be
  updated to reflect any government changes in
  regulations?
• Claims submission audits is coding, billing,
  and documentation in compliance with payer and
  government contractors. Are services performed
  reasonable and support medical necessity?
• Here are the steps to develop and comply with the
  OIG self-audit requirement
• Determine who is accountable for specific roles
  within the organization
• Assign a strong coder who can review the medical
  records and bills for accuracy of the information
  from coding
• Accounts Receivable/Payable work to confirm the
  charges are accuracy for services billed
• Medical Records verify the medical records are
  complete and all diagnosis codes are documented
  and are currently being treated
• Set a time frame The OIG recommends quarterly
  audits
• Determine the number of charts to by reviewed
• Specify the types of accounts to review. For
  example, for outpatient accounts you should
  Review ICD-10 codes Review charges (important
  for potential overcharging or missed revenue),
  and Review providers level of care and does
  their documentation support the level selected

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Self-Audits Crucial for Your Medical
Practice

• Reports should include all your findings the
  good, the bad, and the ugly. Included educational
  resource so the coder and provider can improve
  the accuracy
• Meet with the coders and provider to go over the
  results and office education pointers.
• ADDITIONAL GUIDELINES
• To flag down any potential compliance issues,
  everyone involved in coding and billing should be
  on alert for potential problems. Every employee
  should be tasked to look for red flags to
  indicate a potential problem. Problems should be
  brought to the attention of a designated manager.
  If you want to go this route, be sure to appoint
  a compliance manager who is charged with
  investigating reports of red flags.
• If you dont have enough coders that you can
  successfully have all the work audited in-house,
  we recommend that you hire an outside auditor, or
  have someone in the office who is aware of coding
  perform the self-audit.
• Even though they might take some time,
  self-audits can only help the practice.
  Self-audit carefully, and you can launch a
  preemptive strike on coding and billing problems
  before they become the stuff of nightmares.
• Medical Billers and Coders (MBC) has certified
  medical billers and coders who can assist you in
  self-audits. We can help you to design the
  self-audit program, its execution, and
  implementation of takeaways into day-to-day
  billing practice. To know more about our medical
  billing services you can call us
  at 888-357-3226 or you can write to us
  at info_at_medicalbillersandcoders.com
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