Wiki Billing audit for an 11 clinician Primary Care Clinic/s

sixfoot6

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Hi AAPC. I'm looking for a vendor to audit billing/claims from 2022-current. Must have references and proven credentials. The Clinics are located in Orange County, CA.
 
Hi AAPC. I'm looking for a vendor to audit billing/claims from 2022-current. Must have references and proven credentials. The Clinics are located in Orange County, CA.
Are you asking if anyone in that area knows a good vendor for the audits?
 
Can you, please, settle a difference of opinion between two coders? We work for a private, independent physician. I say when he sees a patient in the hospital we need to scan/upload that document into our chart if we are billing for that visit/service. If there is not a document to support the billing then it didn't happen. The other coder states it is not necessary, that she never uploaded hospital records into the office chart even though they billed for services. I am concerned that if we do not have the documentation to support what we bill then it could raise multiple red flags, especially if an audit were to occur.
 
Can you, please, settle a difference of opinion between two coders? We work for a private, independent physician. I say when he sees a patient in the hospital we need to scan/upload that document into our chart if we are billing for that visit/service. If there is not a document to support the billing then it didn't happen. The other coder states it is not necessary, that she never uploaded hospital records into the office chart even though they billed for services. I am concerned that if we do not have the documentation to support what we bill then it could raise multiple red flags, especially if an audit were to occur.
While there is certainly no harm in uploading the hospital records, it is not required. The documentation does exist. There is no requirement that the documentation must be in your specific EMR. It simply needs to exist and be available. If an audit were to occur, you would need to supply those hospital records of the service provided.
I've never worked for a practice that uploads all hospital visits into a separate EMR.
 
While there is certainly no harm in uploading the hospital records, it is not required. The documentation does exist. There is no requirement that the documentation must be in your specific EMR. It simply needs to exist and be available. If an audit were to occur, you would need to supply those hospital records of the service provided.
I've never worked for a practice that uploads all hospital visits into a separate EMR.
Thank you so much for your response. Can you, please, share what you do in case of a third party audit? We have had outside auditors tell us we must have the records available in the chart at the time of audit. They have said if those records are not available at the time then money paid will be recouped.
 
It's been awhile since I had a third party audit, but anytime I did, we were provided a list of patients in advance. In the event one of those patients received hospital services, you could either have someone access the records at the time of the audit, or print them ahead of time.
To me, available in the chart does not mean it must be in your EMR system. It means they must be available to be reviewed, whether another EMR, paper, or your current EMR.
 
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