Enhance Compliance and Reimbursement with Chart Audits
Published on Fri Jun 01, 2001
Laboratories and pathology practices can strengthen compliance and optimize payment by using periodic audits to analyze coding habits. By scrutinizing coding at each step in the process from requisition through claims processing, practices can identify patterns that result in noncompliance or nonpayment. Audits should compare all documents for a given service, from requisition form to pathology report, to claims and remittance advice. Such a review can spotlight discrepancies that result in lost cash flow and possible charges of fraud.
Chart audits are a method to identify weaknesses in your coding policies, processes and procedures, says Dennis Padget, CPA, FHFMA, president of Padget & Associates, a Kentucky-based pathology and laboratory billing and compliance consulting firm serving more than 150 clients in 25 states. They are a good tool to ensure that you have complete and accurate information to file claims, and that claims are processed accordingly. You can then use the results of chart audits to educate your physicians and staff toward the end of enhanced compliance and payment.
The term chart audit can refer to both internal and external reviews of varying depth and breadth.
Most labs or pathology practices should have external audits periodically, ranging from quarterly to annually depending on the size and needs of the practice, Padget says. But equally important are ongoing, internal audits that, although less far-reaching, are much more frequent say, every week. The weekly audits will generally be limited to fewer elements, while the periodic external audits will be more comprehensive. Chart audits should include review of some or all of the following four elements: pathology or laboratory reports, requisition forms, claim forms and remittance advice.
Review of Pathology or Laboratory Reports
Reviewing a sample of pathology reports is the centerpiece of any chart audit, Padget says. This may involve 25 or more reports for the weekly audit, to 100 or more cases for the periodic external review, depending on the size of the practice.
Some auditors recommend reviewing a specific number of reports from each pathologist, but Padget recommends a frequent, random sampling of charts. A weekly peer review of 25 reports should ensure that the entire cross section of participants is represented, he says. In addition to a larger random sample (e.g., 100 charts) for the periodic external audits, Padget also recommends that these include review of charts for high-risk cases. For example, charts reporting two or more 88309 (level VI surgical pathology, gross and microscopic examination) services or more than four frozen sections (88331 and 88332) should be flagged for review because these are more likely to have coding errors. [...]
