Practice Management Alert

Get your physicians on board for smoother sailing

Medical offices that are striving for the most accurate billing practices should conduct internal chart audits at least twice a year on each physician, but how do you get started? Inventing a chart audit system from scratch may appear to be a daunting task -- but you can pull it off with careful planning and the proper resources.
 
Consider these expert tips for formulating your own internal chart audit system.

First, Get Staff on Board

The most important step in internal audit planning is also the first one, says Susan Hvizdash CPC, CPC-EMS, CPC-EDS, physician educator at the University of Pittsburgh Physicians Department of Surgery and AAPC National Advisory Board member.  
 
Before beginning your audits, you need to -get a -buy-in- from the chief of the department, the senior partner, and then all the other physicians,- she says.
 
Reasoning: -Without their support, you-ll sink before you even attempt to swim. Once you have the buy-in from all the physicians and the support of the senior staff, the internal audit plan should be presented [to the other staff] so that all are aware of what is going to happen,-  Hvizdash says.

Next, Tighten Audit Focus

After you-ve prepared staff for the auditing process, you-ll need to narrow the parameters of your audit, says Curtis Udell, CPAR, CPC, CMPA, senior advisor with Health Care Advisors Inc. in Annandale, Va. You can achieve this by:

 - determining whether the office will perform a prospective or retrospective internal audit.
 - defining the focus of the audit. -What do we want to accomplish; what is the service focus?- Udell asks.
 - determining the audit's scope. Which providers, services, date range and payers will it address?
 - determining how to select charts. Will you fix this process for each provider, or will you randomize the chart selection?
 - pulling charts and organizing supporting documentation, such as a printout of physician notes, account billing history, CMS 1500 forms and explanations of benefits (EOBs).

Then, Check Federal Resources

Once you set the internal audit focus, decide which codes to concentrate on, experts say.
 
When you do this, remember that a practice's top-20 high-volume codes typically account for 80 percent of its reimbursement, Udell says. So focusing on these 20 codes is a good place to start.
 
You should also consider the Office of Inspector General (OIG) work plan when deciding where to focus your energy, Hughes says. The OIG plan, designed to help practices adhere to federal guidelines when billing, is online at http://oig.hhs.gov/authorities/docs/physician.pdf.
 
What is it? The OIG's Work Plan outlines the watchdog agency's hot-button issues for Medicare and Medicaid billing.