Ophthalmology and Optometry Coding Alert

Question: We are getting an outside party to conduct an audit to evaluate our practice’s performance. What should we consider and do before an agreement is reached and an engagement letter is signed?

Nevada Subscriber

Answer: Before you have them sign an engagement letter or agreement, you should decide on the scope of the audit. Ironing out details like ‘why’ and ‘how’ ahead of time protects both your practice and the person doing the audit. Failing to clearly define the audit can result in “scope creep,” which can then add on not only time but also increase the monetary cost of the audit.

You’ll also want to identify the tools and/or resources used to perform the audit within the scope and engagement letter/agreement to be signed. If you are utilizing a tool from a particular vendor, you should identify that tool by name. Possible resources include:

• ICD-10-CM book for identified years, or in the unlikely event you want to audit records going back before Oct. 1, 2014, ICD-9-CM.
• CPT^® professional edition for a particular year, especially if performing a retrospective review
• Medicare or Centers for Medicare & Medicaid Services (CMS) guidance and applicable transmittals
• CPT^® Assistant
• AHA Coding Clinic
• Fee schedules, if the revenue variance is to be calculated

Make sure you obtain a signed business associate agreement from the auditor prior to sharing any documents containing protected health information such as chart notes, operative notes, and coding history.