Avoid these 8 steps to Reduce your Medical Coding Audit Risks
Data & Analytics usage has made easy for the payers to identify coding and other “outliers” and in return, track for audits. With a stated goal of recovering over $2 billion in “incorrect payments” it’s a bit more critical than ever for practices to be in compliance. A good tax expert on your team can also reduce accounting errors and other red flags, many practices commit documentation and management mistakes that can lead straight to the auditor’s office. But there are ways to reduce those errors and reduce audit risks in your medical practice.
- Avoid the overuse of Levels 4 and 5 in E/M Codes
The billing department’s responsibility is to avoid under-coding for E/M (Evaluation and management) visits, as well as the overuse of level 4 (care for established office patients) and 5 (care for established patients being seen in the office). Both the mistakes will cost a practice’s revenue, and in the case of overuse, it could lead to reimburse payers for over payment.
- Avoid errors with an independent audit
Your claim procedures often audited by an outside contractor may result in medical billing errors as well as it keeps adhered to compliance regulations while improving recovery. A one-time audit will actually show insufficient to show patterns where problem lies in an audit; a regular basis audit is much more preferable.
- Avoid crowding with patient’s information
When you are using templates in EHR (Electronic Health Record) systems, there’s this risk of crowding it with the information of a previous patient. Until and unless such information is absolutely relevant in respect to clinical aspect, the information should be avoided or some notes should be added in relevance of other informations related with the earlier visits. With the auto- generated patient histories and templates there is a possibility of your EHR automatically up-coding billing.
- Avoid an overlook on patient’s and employee’s needs
Your practice has to keep track of the patient’s experience satisfaction rates, and this also ensures that important services and task, for example – lab test reports are not being ignored and every visit of the patient is documented. Maintaining a standard for employee performance assures further that practice tasks and services will help avoid confusion, and mistakes which can lead to audits if not rectified.
- Avoid an ignorant attitude regarding your business plan
Many practitioners give the business concept merely on words; they believe that the problem will be taken care by itself by allotting the tasks to competent office help along with a tax expert while they focus their attention on delivering care. But, with the pro-active attitude and putting a detailed plan in place for assessment risk for billing issues and IRS deductions, you can dodge situations resulting in a trouble.
- Avoid Inappropriate Use of Modifiers
Modifiers are added to the HCPCS (Healthcare Common Procedure Coding System) or CPT( Current Procedural Terminology) codes to identify why a doctor or other qualified healthcare professional provided a specific care and procedure. Not all modifiers can be used with HCPCS or CPT codes.
Misusing with medical billing modifiers can trigger an audit that can lead to heavy fines. And these audits can be as high as $10,000 for each occurrence so it’s better to keep track of the bill, which is made for the modifier.
- Avoid the insufficient documentation process
As organizations acquire practices and open new clinics, the number of outpatient care locations increases. Accordingly, outpatient coding, documentation and charging become more important to ensure quality reporting and reimbursement – and to reduce and prevent denials. These procedures are necessary because lack of proper documentation improvement or query processes can lead to missing or insufficient documentation to support the claim.
- Avoid duplicate billing
This kind of issue occurs when someone at the provider’s office submits a claim for procedure without checking whether that service has been paid for/reported. These duplicate bills can be a huge headache for billers and payers alike because it would be like a patient received two x-rays on one day, which would result in the two times of the amount sent to the payer.