
It can be challenging to see a medical insurance audit as anything other than a headache. After all, auditors require reams of documentation, and there’s always a chance they’ll uncover a missing CPT code, an undated progress note, or another issue that requires you to pay back what you received from payers.
However, you may learn a few lessons if you’re subject to a medical insurance audit. Read on to learn a few of them.
1. Improve Future Compliance
In some practices, it’s the providers who are contributing to inappropriate coding, billing, and documentation behaviors. And when that’s the case, providers may not necessarily pay attention when support staff advise them to change their habits. However, when the news comes from an auditor, providers are more likely to listen.
An internal audit can raise practitioner awareness of faulty proceedings or even employees. If any fraud is found, it should be reported to the entire staff to ensure future compliance and growth.
2. Optimize Staff Training
Employees tasked with billing and coding should be properly trained and well prepared to minimize the risk of human error. Therefore, it’s always advisable to revisit training frequently even if there does not seem to be an evident problem to make sure all employees understand the tasks expected of them and that they feel comfortable with them. This is particularly important as rules change, such as at the beginning of a new year, when CPT codes and payer guidelines are updated.
Frequently revisiting training helps ensure that you tackle issues from the beginning and make corrections as necessary to be in alignment with what the regulatory requirements are.
3. Correct Existing Billing and Coding Processes
Billing and coding errors that seem patterned or susceptible to future fraud should be carefully reviewed and adjusted accordingly following an audit, whether it’s internal or external.
Findings from an internal audit can be used to correct current procedures in accordance with local and national coverage policies and prevent future mistakes.
4. Shape Future Programs
Finding from an audit should be used to frame current procedures and prevent future mistakes. For instance, if you find that all of your preventive visits are billed one level higher than they should be, it may be the seed for an idea to create a preventive visit documentation seminar at your practice, or could lead you to develop preventive visit documentation templates.
Always evaluate any audit findings you receive and analyze them to look for lessons that you can take from them to make your practice run more smoothly.
Audits may be scary, but they don’t have to be. Healthcare attorney Osato F. Chitou, Esq., MPH can walk you through the most important steps how during her online training event, Medicare Audit Survival Tactics to Help Your Physician Practice. Sign up today!
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