Should the patient you just saw have been billed as a 99213 instead of 99214?
Would the testing you usually do for a 92004 survive an audit?
For the procedure code you used for your last patient last night, were you supposed to have dilated that patient?
Does the history you just took on your last patient today qualify for a higher level code than the one you used? How often do you do that and how much money have you lost doing so?
To help answer questions like the above as well as others that routinely come up, we’re happy to announce a new chart auditing service. Here’s how it works:
1. Choose 10 charts at random and photocopy those charts. If you’re using EMR, print out 10 charts. Black out the patients name or any other obvious identifying information like social security numbers.
2. Snail mail the charts to us.
3. We will audit the charts for proper billing and coding compliance. Here’s a brief synopsis of what we’ll do:
♦ Assess the documentation of your medical office visit, including consultations
♦ Grade the 3 elements of EM services (History, Examination, and Medical Decision Making)
♦ Grade the 3 elements of Ophthalmic services (History, Examination, and Diagnosis & Treatment)
♦ Gauge the legibility of your notes
♦ Evaluate chart corrections with respect to professional liability exposure
♦ Evaluate the diagnosis code for matching the service and proper number of digits
♦ Provide an appropriate billing code that is supported by the documentation
♦ Suggest possible missed fees
4. Once the audits and recommendations are made, we will shred the charts and email a report that explains our recommendations.
5. Once you review the recommendations you will have the option to set up a phone call (up to one hour) to review the findings.
Here are the three most commonly asked questions and their answers about the PowerAudit:
1. What is the purpose of the PowerAudit?
♦ Determines what has been done and see if it can be done better.
♦ Ensures the doctor is submitting appropriately coded claims according to CPT codes, guidelines and conventions, and payer payment policies.
♦ Measures compliance & assesses how well a practice is following federal & private insurance guidelines.
♦ Shows which level of service is documented & billable.
Federal regulations & private contracts require medical record documentation to justify charges. The doctor is ultimately responsible for claims submission, even if a billing service or clearinghouse is used for claims submission to payers.
2. How often should the PowerAudit be performed?
♦ The OIG (federal Office of Inspector General) recommends that practice audits be conducted at least annually, and that they be used to identify risk areas such as coding and billing, reasonable and necessary services and documentation requirements.
♦ The American Medical Association (AMA) recommends an annual audit, or when new doctors or billing staff are hired, to identify and address potential errors promptly.
3. What are the benefits of the PowerAudit?
♦ Improved Cash Flow through timely, appropriate payment and fewer denials.
♦ Lessens Risk of Penalties from outside auditors through detection of incorrect billing patterns.
Sign up for our PowerAudit service by clicking here and find out the answer to the above and other questions that can have a DRAMATIC effect on your profitability! Once you sign up, we will email you with the next steps to start your PowerAudit.
Remember – audits are a significant benefit to any doctor who wishes to lessen the risk of penalties from outside auditors, and improve cash flow from insurance claims!