Medicare Compliance & Reimbursement

Self-audits aren't only necessary if your practice has been scheduled for an OIG audit.

What it means: When you perform a self-audit, you're comparing your physician's billing records, claims, and medical records to verify expected treatment outcomes and medical necessity of services. In addition, you'll look for appropriate documentation to support fees and reasonable charges for services your physicians rendered.

Why you audit: When you audit your physician's services, you can uncover incorrect coding patterns or compliance issues. The plus here is that you'll discover any problems before an outside auditor (such as one from the OIG or a private insurer) does.

Checklist: If you don't know quite where to begin when you perform your first self-audit, keep this handy reference as a guide to remind you what types of questions you should be asking yourself. For each chart, make sure you can answer the following questions and you'll know you've done a thorough job:

• Does the documentation support the level of service billed?
• Does the documentation support the CPT^® and/or HCPCS codes billed?
• If the physician coded a consult, does documentation of a request from a third party exist in the chart?
• Does the chart contain a written consult report back to the third party?
• Did the physician use modifiers correctly?
• Does the documentation support the ICD-9 codes the practice reported?
• Did the physicians sign and date all entries?
• Is the chart legible?
• Is the name and identification number of the patient and provider on each page of the medical record and claim form?
• Does the patient identification sheet include completed biographical data, including the patient's address, employer, home and work telephone numbers, and marital status?