Practice Management Alert

Perform In-House Audits to Avoid House Calls From Auditors

Published on Sat Jul 16, 2005

Tip: An outside billing company may find problems you've missed

If you're not updating or monitoring the claims your billing software produces, you could be outputting claims with invalid - or worse yet, incorrect - codes. Prevent visits from the feds with these simple methods.

Audit More Than Annually

Doctors really need to be careful about scrubbing software that lets them know whether a claim is payable or not, says Liz Menduke, CHBME, owner of Primary Billing Services Inc. in Torrence, Calif.

"Perform audits at least on a quarterly basis, if not more frequently," says Adrienne Pemstein, founder and owner of River Oaks Billing Service in Fair Oaks, Calif. "If you find an error, you want to make sure you catch it prior to the insurer's timely filing deadline."

Check Claims Yourself

If you decide to perform your audits in-house, take the following steps, Pemstein says:

Make sure you're really billing the proper codes for the procedure the physician performs

Make sure the proper dollar amount for the procedure is billed and paid. For example: If the surgeon performs two extractions, D7140 (Extraction, erupted tooth or exposed root [elevation and/or forceps removal]), and you don't put "2" in the units box, you will only receive payment for one of the extractions, or half of what you request on the claim form, Pemstein says.

If you discover an underpayment, contact the insurer to review and correct the claim. Send the payment once the insurer sends an EOB retracting the payment and a letter requesting the new dollar amount, Pemstein says, and attach a copy of the letter to the check along with the claim number so the payment goes where it should.

Sonya Corsey, billing manager for Oral and Maxillofacial Surgery at the University of Pennsylvania Medical Center in Philadelphia, says the internal compliance department performs audits for them. The audits uncover minor problems, such as undercoding issues and some misunderstandings of the criteria for a new patient visit, she says.

Have a Clearinghouse Check Your Claims

If you want a second pair of eyes to check your claims, consider a clearinghouse.

"We do our own in-house auditing, and we've caught small things," says Bobbi Michaels, office manager for Oral & Maxillofacial Surgery Center PC in St. George, Utah. "Our electronic claims also go through our clearinghouse and they check to see if we've missed something."

Hire an Outside Billing Service

A third option is to hire an outside billing service to handle all of your billing or just perform your quarterly audits.

A professional, accredited billing service will have internal audits in place and provide a new set of eyes to examine the claims, Menduke says. They're strictly monitored by the Office of the Inspector General billing guidelines and are more likely to have certified billing personnel who know how to perform audits correctly, she says.