By Mark Wright, OD, FCOVD,
and Carole Burns, OD, FCOVD
Sept. 4, 2019
In today’s world, audits are not a question of if, but a question of when. It’s always better to stay prepared for an audit than to live a life of regret after the audit. Here’s what you need to do to make your practice audit-ready.
Attend at Least Two Hours of Coding & Billing Education Every Year
Every year there are changes to the coding and billing rules. To stay on top of these changes, make sure you attend coding and billing continuing education every year. Make sure the courses you attend highlight the changes, not just the basic coding and billing.
“Code appropriately” means do not over-code and do not under-code. Some doctors think that if they under-code they are reducing their risk of audit. What they don’t know is that under-coding is as much of a problem to an auditor as over-coding. The solution to this is to just code appropriately.
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Engage Your Staff
You can’t remember everything all the time. Engage the help of your staff. Teach them what to look for in a record, they can help make sure that everything is documented correctly and that every test completed is listed in the patient record.
Review at Least Five Patient Files Per Year Per Carrier
Every year you should randomly pull at least five patient files per carrier and audit them yourself. Follow the record all the way from the appointment scheduler to the reimbursement from the carrier. Is every step documented accurately? Is the record coded appropriately? Was the payment correct?
Decide Who Will Meet with the Auditor
If the auditor is coming into your office, you need to decide who will meet with them. It is not necessary to cancel patient visits just so the doctor can meet with the auditor. If you’ve prepared properly for the audit by following the steps above, then you can have confidence in your system and you should be fine in the audit.
Take these steps and review this article every year to make sure your practice stays audit ready.