Audits

Audits can be overwhelming for several reasons. In addition to the possibility of having to return payments, an audit can drain time that you don’t have. It can also be downright frustrating to try to explain that yes, it was medically necessary to perform the procedure reported.

However, getting audited doesn’t automatically mean you made a mistake. Even if you did make a mistake, a single finding on an audit probably isn’t going to make or break your career.

The art of preparation

Ideally, you will avoid getting audited in the first place. Conducting internal audits can reduce the likelihood of an external audit. Internal audits also offer your practice the opportunity to spot patterns. If certain procedures or diagnoses tend to be the usual culprits, then you may have pinpointed an area to focus on for an office-wide coding refresher.

Aim to review 10 to 15 records per year for each established physician, and 10 to 15 records every six months for each new physician. Audit records pre-submission to Medicare so that you can catch problems and correct errors before they draw an external audit.

Even with internal audits and careful documentation, you may still find yourself getting audited. That’s why it’s important to have a compliance plan in place. Make sure that everyone in the practice knows not to change any documentation.

Will you survive the audit?

If you’re getting audited, you want to make sure that it goes as smoothly as possible. If you’ve documented everything carefully and accurately, the auditor may come back and say that you don’t need to repay. However, not all audits are that easy.

Here are 12 things you need to do to make sure that you pass the audit with flying colors.

1. Use the right code. Always double check this!

2. Use modifiers correctly. Modifiers can make the difference between keeping your money and giving it back. Watch out for the tricky ones, such as modifier 24 (for services performed within the global period after a surgery) and 25 (for services performed on the same day as a surgery).

3. Ensure that medical records are clear and ready to be examined. If you can’t find or understand the record, neither will the auditor.

4. Avoid chicken scratch notes. If you use handwritten notes, and they’re difficult to understand, the auditor won’t be able to determine the reason for or the care provided.

5. Authenticate the record. Sign and date everything. An unsigned record can result in a denied claim.

6. And sign clearly. Legible signatures are just as important as legible clinic notes. If your signature is a bit messy, but still recognizable, maintain a log of your signatures so an auditor can match the signature to the one in the record.

7. Answer the auditor. If the auditor sends over multiple requests, log each one separately and make note of when each one is answered.

8. Be thorough. Include just enough information to provide the auditor with a clear understanding of why the encounter took place and what occurred during and as a result of the encounter.

9. Document your E/M services extremely well. Depending on the year the E/M encounter being audited occurred, the encounter may be based on key components, MDM, or time. Regardless of the E/M guidelines used, the documentation must support the level of service reported.

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