The Billing Administrator’s Guide to Surviving a Medical Coding Audit

Follow these tips to make audits less time consuming (if not any more fun).

Audits.To many billing administrators, perhaps including you, they sound about as appealing as root canals or tax returns. But they’re a fact of life in the healthcare industry. And with increasing pressure to keep Medicare solvent and safe from fraud, medical coding auditing is bound to become more frequent, not less.

No matter how careful and conscientious you are, audits cannot always be avoided.  But you can take action to increase the likelihood that the codes it submits stand up to scrutiny.

That action begins, of course, with submitting the most appropriate, fully documented codes possible. MDCodePro is a valuable tool your practitioners can use to do just that. The practical result of thorough and systematic study of CMS billing regulations, MDCodePro gives physicians an easy way to code every patient encounter as accurately as possible, which positions your organization for successful audits.

Here’s a brief overview of other things you can do to not only survive an audit, but also emerge stronger on the other side.

Facing a Medical Coding Audit? Here are 4 Things to Do

You may feel powerless when staring down an audit, but you are not. Here are four good steps to take:

  • Get professional, experienced help. “The payers are becoming very tenacious,” Angela Miller of Medical Auditing Solutions told Physicians Practice, “so hoping for the best in an audit is ‘naive.’” Check with legal counsel before doing anything, including contacting the auditor. And if your lawyer recommends you hire a medical coding consultant to review requested records, do it. The consultant may even give advice that will lower your chances of being audited in the future.
  • Respond promptly. The temptation to ignore an audit notice in the vain hope it will go away is a strong one. Resist it. If you drag your feet, the payer may go ahead and start issuing denials, turning what might have stayed only a minor problem into a major one.
  • Don’t alter records. This piece of advice might seem self-evident. But some physicians want to clarify or provide extra documentation when questions arise. Explain something if needed, but not by changing records. Medical chart auditing companies could construe alterations as attempted fraud. Don’t let physicians risk losing their licenses; have them attach a written note to records instead.
  • Keep a paper trail. Send all audit-related paperwork via certified mail, and keep a detailed written record of correspondence with the auditor. If you do this, you’ll have a paper trail that can be traced should anything go missing on the auditor’s end.

Why Internal Medical Coding Auditing is a Must

medical coding auditing According to Medicare fraud investigator Wayne van Halem, “Providers who are not proactively preparing for these audits are going to be in trouble. The ones who are working as ‘business as usual’ are…having the most issues now.”

The most proactive thing you can do to survive external audits is to conduct internal audits first. On a regular basis (as often as every month,) review your records for potential audit triggers or “red flags” before outside authorities find them.

“An internal or external coding audit is not one of the more inviting events in the medical practice,” writes Jeri Leong, RN, for the Advance Healthcare Network for Health Information Professionals, but “it has proven to be one of the more important ones.” Leong offers internal audit teams several practical tips for success, including:

  • Make sure reference materials (coding manuals, NCCI edits, and CMS or other third party policies) are current and appropriate for services being audited.
  • Examine copies of CMS claim forms and charge tickets to verify the accuracy of billed services and to identify potential problems like “data entry errors, use of outdated code sets, or improperly sequenced surgery CPT codes (which can result in inappropriate payments.”)
  • Summarize your findings in an easy-to-read format (such as a spreadsheet or dashboard report) that highlights correct coding as well as mistakes, in order to avoid giving your practitioners nothing but negative feedback.
  • Follow up through one-on-one meetings with physicians, written recommendations for updated policies and procedures, and formal continuing education about coding challenges.

Does establishing a regular, rigorous internal medical coding auditing process require a lot of work? Yes. But it can save you and your healthcare organization a lot of work, a lot of pain, not to mention a lot of money, in the long run.

Plus, internal audits bring other benefits, too. They can uncover knowledge and practice gaps for continuing education to address, strengthen communication within your organization, and push you toward more efficient delivery of care. Internal audits are an investment in your organization’s current and future well-being.

Let MDCodePro Teach Your Practitioners to Optimally Code Their Visits

As Doug Kraus, CFO at South Texas Radiology Group, told Diagnostic Imaging, “In a day when we’re all under the microscope, you have to have systems in place” to ensure that all that can be done before bills go out is being done.

One thing you can do right now to help your organization survive medical coding audit is to equip your practitioners with MDCodePro. Designed for busy physicians and other healthcare professionals, this easy-to-use app, suitable for both desktop and mobile browsers, helps them document patient visits more accurately, more thoroughly, and more profitably.

MDCodePro contains a powerful code generator that returns each visit’s optimal CPT® code based on information physicians submit. It also features a series of video lectures in which Dr. Alexander Stemer, MDCodePro founder and Medicare billing regulation expert, explains optimal coding principles in clear, easy-to-follow fashion.

While MDCodePro is not comprehensive medical coding auditor training, it will teach your practitioners to code their patient visits accurately and optimally. And because audit after audit has proven its methodology, it can ultimately make your organization’s next audit a lot less challenging.

To discover more about how MDCodePro can benefit your organization’s medical coding, call us at at 219-301-7265, or fill out this form to request a demonstration.

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