Practice Management Alert

Tip: Begin with a baseline audit and then make changes before outside auditors come knocking Would you pass an audit if a payer auditor showed up at your practice door? You should be using internal chart reviews to evaluate your practice's compliance and billing processes -- before someone else does. Performing internal audits doesn't have to be painful and time consuming. Take a look at these expert tips and formulate your own internal audit system. Reap the Benefits of Internal Reviews Performing internal audits can help you ensure billing and coding compliance and may also help you find money you-ve been leaving on the table, says Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley and Associates in Clearwater, Fla. "Not only is this important -- it is crucial to a practice's success," adds Susan Garrison, PCS, FCS, CCS-P, CHC, CPC, CPC-H, CPAR, executive vice president of Magnus Confidential Inc. in Atlanta. "Finding problems early helps alleviate risk. Additionally, internal audits might point out when you need to bring someone from the outside in to help." Audits will also uncover inconsistencies in documentation and coding so you can focus your staff education. "Maybe something conveyed was misunderstood, or confusing, and that will come out in the audits," says Suzan Hvizdash, CPC, CPC-E/M, CPC-EDS, medical auditor for University of Pittsburgh Physicians. "Without regular internal audits you would have no idea how the practice is doing with regard to its compliance of the regulations and guidelines." Tip: Refer to these internal audits as reviews, Hvizdash suggests. "That way they are not as threatening as the word -audit- may convey," she explains. Mac agrees: "An audit gives the essence of seeking mistakes and problems that require recoupment, so I call them reviews," she says. "Reviews are more judgmentally selected encounters based on coding patterns and problematic areas and are designed to get a statistically valid sample." Start With a Baseline Evaluation You want to begin your audit efforts by performing a baseline audit -- the first comprehensive audit your practice undergoes. Then you can decide how often you will perform internal audits each year. Why? With the information gleaned from a baseline audit, you-ll be able to streamline future auditing efforts and focus on the most important areas to your insurers. Your goal is to get each provider and each biller as close to 100 percent compliance and accuracy as possible. The baseline will help you decide how frequently you need to perform future audits and also help you determine the areas for improvement that your practice should focus on between audits to increase the compliance percentages. Going forward: How often you perform internal reviews after the baseline audit depends on [...]