Otolaryngology Coding Alert

Question: We conducted a self-audit to make sure our ENT practice stays on the right side of the coding rules. The review is done but we’re not sure about the next steps. Can you explain what to do once an audit is done?

AAPC Forum Participant

Answer: Once the review is complete, you must decide what you will do with the results. If the audit was done prospectively, the claims should be billed according to the findings of the audit. This may demonstrate the need for further retrospective review.

On the other hand, if the audit was performed retrospectively and the claims have been submitted, corrected claims should be resubmitted for changes to codes or payments based on audit findings.

If the audit was done as part of attorney engagement, then legal counsel should determine if self-disclosure will need to be done and if payback will be given to the payer.

Follow-up education is also key and should be timely and targeted. You must decide if the education will be group or individual. Remember, your compliance and auditing program will not be very effective if you never educate your providers and staff on how to do it right.