Home Health & Hospice Week

Spend more time on billing audits, less on compliance, say experts.

Conducting audits on 100 percent of your charts won't guarantee 100 percent compliance ...quot; and such overkill could be taking your focus away from better billing practices. Use these audits to examine the big picture and use the time you save to focus on billing audits, say experts.

Reality: Even if your agency audits every single chart for compliance, surveyors will still manage to find something wrong, says Karen Vance, with BKD in Springfield, MO. You can save time by reviewing a random sample for compliance--and put the saved time to better use by establishing a thorough billing audit process.

Benefit: A quarterly audit can uncover a variety of areas for improvement, says Ann Zeisset, with the American Health Information Management Association in Chicago, IL. Some trends or patterns that could be potential risk areas include:

• Code choices that aren't supported by documentation;

• Not reporting ICD-9 codes for diagnoses included in the documentation;

• Violations of official coding guidelines;

• Not being compliant with third-party payer directives; and

• Codes assigned but not reported on the claim form.

Make the most of your audit time by looking for trends and patterns, suggests Vance. Process Simplifies Your Job

These simple steps can help you to build an effective and time-saving compliance audit process:

1. Select a random sample of charts to audit. Organize charts by dates of service and then select every fifth chart, suggests Zeisset.

2. Perform a base-line audit once you've established your sample. Check each chart for coding and billing errors. Your sample should include records that involve various payers, nurses and physicians, says Zeisset.

Example: You find that staff are using the diagnosis 781.2 (Abnormality of gait) frequently to support therapy. However, the audit reveals that this diagnosis is being used for gait problems because of the pain of arthritis or lower back pain and substituted for long-term diagnoses when a long-term diagnosis may have been more appropriate.

3. Follow through. After you have conducted an audit and created a plan to address any patterns or trends, make certain you follow through and make those improvements, says Zeisset. For instance, you might educate your staff on when it's appropriate to use symptom codes like abnormality of gait and how to ensure that documentation supports their use.

4. Monitor your progress. Develop a monitoring process. Measure compliance and clinicians' response to training about the findings, as you continue to monitor any risk areas the audit uncovered, Zeisset says.

Establish A Claims Auditing Process

While quarterly compliance audits can focus on a sample percentage of charts, Vance recommends auditing all of your claims before submitting them. This is one area where auditing 100 percent of your records can pay [...]