Urology Coding Alert

Self-audits are well worth the time, experts say Although some coders believe that self-audits are only necessary if your practice has been scheduled for an OIG audit, there are many other reasons why chart reviews can help your practice. For one thing, you could be throwing money away if you’re not auditing your charts regularly.
 
“Chart audits are a good way to pick up things that aren’t billed, and then things that are billed but aren’t documented,” says Maxine Lewis, a consultant with Medical Coding Reimbursement Management in Cincinnati. You may actually rescue some money with audits, and you may avoid compliance nightmares.
 
What it means: When you perform a self-audit, you’re comparing your physician’s billing records, claims, and medical records to verify expected treatment outcomes and medical necessity of services, says Susan Vogelberger, CPC, CPC-H, CMBS, owner and president of Healthcare Consulting and Coding Education in Boardman, Ohio. In addition, you’ll look for appropriate documentation to support fees and reasonable charges for services your physicians rendered. 
 
Why you audit: When you audit your physician’s services, you can uncover incorrect coding patterns or compliance issues. The plus here is that you’ll discover any problems before an outside auditor (such as one from the OIG or a private insurer) does.
 
Before you perform your first audit, you should make sure you have current CPT Codes , ICD-9 Codes and HCPCS Codes books available. And get your most recent National Correct Coding Initiative (NCCI) edits close at hand, along with local medical review policies, E/M guidelines, and a medical dictionary for reference during the audit.
 
Who should participate: You should involve every member of your practice in your audit, Vogelberger says. In particular, you’ll want to hold a staff meeting before the audit to explain what you’re doing and why, and to remind staff members that you’re not trying to get anyone in trouble. Instead, you’re hoping to help them figure out what they’re doing right, and determine what they should work to improve that will help the practice ethically bring in more reimbursement and decrease denials.
 
If your practice has never performed an audit, you should consider the following factors so you can determine how many records to audit:
 
• your annual case volume
 
• the number of physicians in your practice
 
• the number of coders and billers in your practice.
 
You should audit at least 10 to 15 records per physician if you’re in an outpatient practice, or 5 to 10 percent of the records [...]