Protect Against Medical Records Documentation Errors, Audits and Fines

Even simple medical records documentation errors — like forgetting to include a provider’s signature — can render an entire patient encounter unbillable and set you up for a costly and stressful audit.

Medical Records Documentation Specifications

Medical records documentation requirements go far beyond recording a patient’s medical history, diagnosis, and the services you performed. Like it or not, payers use your documentation to justify every patient visit, and there are very specific legal guidelines you must comply with to protect your practice.

With payers and auditors cracking down on documentation compliance, your best bet is to pinpoint and avoid red flags in your medical charts that will get you targeted. But you must know what they are first.

That’s where healthcare attorney Amanda L. Waesch, Esq. comes in. During her online training, Amanda will provide you with the essential medical documentation guidelines your charts must meet if you want to stay within the legal guidelines. During this 60-minute online training, Amanda will help you identify, resolve, and avoid the medical record errors that trigger payer audits and lead to fines and penalties.

Audit Proof Your Medical Documentation

Check out just a few of the practical medical documentation strategies you’ll walk away with by attending this online training:

• Master medical documentation amendments you can and can’t legally make
• Pin down what constitutes a chief complaint and get more claims paid
• Comply with medical record signature requirements quickly and easily
• Uncover how long to keep charts open and when chart locking is legally required
• Qualify who can and can’t sign a medical chart – it may not be who you think
• Utilize specific medical necessity verbiage that is proven to cut denials
• Steer clear of easy-to-make documentation violations when using scribes
• Bulletproof your charts by knowing what acronyms to avoid
• Document to protect against malpractice allegations when patients refuse services
• Concrete tactics to comply without over- or under-documenting
• Sidestep the most common documentation errors that will get you audited
• And so much more…

Legal Requirements of Medical Documentation

Medical records are considered legal documents, supporting every aspect of patient care along the way, and auditors are just waiting for your practice to make a medical documentation mistake. All it takes is one simple misstep to get you audited. From there, violations, penalties, and unpaid claims follow.

There’s a lot riding on the accuracy and compliance of your medical documentation, from reimbursement to legal requirements and beyond. By attending this expert-led online training, you’ll get the practical strategies you need to reduce delayed payments, halt reimbursement recoupments, avoid audit triggers, prevent fraud allegations, and sidestep expensive violation penalties. Sign up today!