Wiki Medicare required third party external audits

[stephsaylor30@yahoo.com]

Hello,

I'm a CPC at a four provider family practice. We understand we are required by Medicare to have an independent third party audit of our provider's documentation. We learned at the most recent OSMA symposium that one option to meet this requirement is finding a similar sized practice of the same specialty with a CPC and "swapping" auditing services. We are very interested in this sort of mutually beneficial arrangement. If any of you or someone you know are a CPC at a primary care, internal med, or family practice and would be willing to network with me and possibly accomplish our required audits together please email me at stephsaylor30@yahoo.com.

Thanks,
Stephanie

 

[Spring2Code]

Hi, you can create your own internal audit. At my last company, I performed monthly documentation audits on selected doctors then pulled random records of those selected doctors. Usually with in the past 45 days. Then every 3-4 years we would have a 3rd party Corcoran Consulting Group come onsite and audit. They specialize in Ophthalmology and Optometry coding and reimbursement. I have listed CMS reference and link below. Hope this helps!

Whether providers develop or borrow an audit tool from another organization that fits the
specific needs of their practices, the tool should include expected medical record documentation, coding,
and billing standards.[10] Choose a staff member who understands documentation, coding, and billing
principles to complete the audit. Choose a random sample of records for a specific time period to review.
Decide how many records to review, and then pull every “nth” chart for that time period. As part of the
audit, track all audit findings. In addition, review and track billing remittance notices

https://www.cms.gov/Medicare-Medica...ownloads/docmatters-officestaff-factsheet.pdf

 

[stephsaylor30@yahoo.com]

Thanks for responding! We already have an internal audit process in place. We need to find a cost effective way to have an independent external audit. We are trying to avoid hiring a consultant to do the external independent audit by "swapping" audits with another practice who has a CPC on board. They would audit our provider and I would audit theirs. This was an option outlined by an attorney speaker at a recent OSMA symposium as a way for small practices to meet this requirement without the expense of a consultant.