Practice Management Alert

Make sure you know whether an attorney is involved before you begin.

We shared some expert tips on smoothing out tough conversations with providers after an audit earlier this year, Volume 23 Number 1. Now, we’ll offer some expert advice for navigating potentially tricky communications with C-suite executives.

Helping the C-suite understand some of the challenges physicians face ultimately helps the physicians, said Kim Huey, MK CPC, CPCO, COC, CCS-P, PCS, CHC, a coding reimbursement compliance consultant, in an AAPC AUDITCON session “Best Practices to Communicate to the C-Suite.”

“When we communicate with the C-suite, especially if we have to communicate not-so-favorable information, we want to be very precise,” said Sandy Giangreco Brown, MHA, BS, RHIT, CHC, CPC, CCS, CCS-P, COC, CPC-I, COBGC, PCS, in the same presentation.

Keep Profit Within the Scope

C-suite executives are facing different pressures than providers, especially because money is usually a top concern: Executives are worried about profit and productivity, and those pressures can trickle down to providers. So, if you can focus on those bigger-picture worries and build out your reporting with that angle in mind, you may be able to connect with executives in a way that communicates the necessary information effectively for everyone.

Top tip: Keep executives informed from the start. Presenting an audit report, especially if there’s unfavorable information involved, to an executive who had no idea an audit was being performed makes any conversations that much harder. Instead, open the communication early: “Here’s the scope, here’s what we looked at, here are our results, and here are recommendations,” Huey recommended.

Think, too, about what kinds of change executives can really control. For example, there are legal requirements with which providers may comply. Since higher-ups can’t really do anything about that, it may not be worth including in the report for the C-suite, Huey said.

Beware How Legal Efforts Can Affect Audit, Report

Attorneys sometimes request audits after a practice or provider has been engages their services. In those situations, it’s helpful to know whether the audit is being performed alongside a payer review or if there’s any anticipation of having to pay back money.

It’s also helpful to know whether there are other legal actions or appeals, which may depend on the audit results — and whether the audit is part of the investigation.

If attorneys are involved, you may need to keep attorney-client privilege in mind and follow the respective guidelines.

“If we’re doing something under attorney-client privilege, it requires an attorney-client relationship. We’re doing an audit, we have to be engaged by the attorney, and then all of our deliverables and so forth go to the attorney, and then the attorney turns it over to whomever,” Giangreco Brown said.

Attorney-client privilege governs oral or spoken communication and reports, Huey explained. Work product, which includes memos and notes and other documents you’re working with, is also protected if it’s prepared in anticipation of litigation, she explained.

Both of these types of protection may be helpful for an individual or organization if they’re facing litigation, including from a government agency like the Office of Inspector General, because otherwise all kinds of things may be liable to submission as discovery, she said.

Be Mindful of How You Frame Results

It’s important to think about how audit results may play out.

For example, if the audit results show that some services offered by the practice or a particular provider aren’t supported, and the auditor therefore makes recommendations surrounding those services, compensation may be impacted, Huey said.

“So we always shave to understand the different complexities at different practices. When we’re doing these types of reviews, we’re going to need to be mindful of that as we’re reporting it out” she said.

Keep in mind, too, that executives may care more about dollar impact versus, say, a provider’s accuracy. Huey said it’s helpful to know whether to prioritize the financial aspects in advance, because she’s had that requested of her after the fact and going back and calculating can be a little “cumbersome.”

As with all audits, it’s helpful to look for — and constructively frame results around — missed opportunities.

Giangreco Brown offered an example of a provider performing a procedure in an office but forgetting to report and bill that aspect. In such a situation, a provider may be undercoding the encounter, which means missed money.

If you have the opposite situation, where you find during an audit evidence of overpayment, be ready with your policies and procedures as proof of the practice’s obligation to refund the excess, Giangreco Brown recommended. It can be helpful to state that obligation at the beginning, too, before the audit is conducted, so stakeholders are reminded of the obligation before any talk of refunds arise.

Make sure you really nail down the scope of the audit and prioritize clarity in conversation. Know and communicate the objectives, the scope, and the ways in which the samples will be chosen and evaluated, Huey said. Also, demarcate what’s included and what is not included, like whether you’re looking at a particular commercial carrier or just governmental payers.

“Otherwise, the C-suite is likely to take this report and assume you looked at everything,” Huey said. “Maybe they’re thinking you didn’t find any problems because you didn’t mention it. But the fact is, you didn’t look at it. So, I can’t emphasize that enough: Be very clear.”