When is the Best Time to Audit?

Before an Insurance Company Comes Looking!

I bet you guessed the answer. It’s now before an insurance company comes looking! There has been an abundance of records requests since the beginning of this year. I would imagine the providers that are receiving these requests wish they had initiated a chart review themselves before someone else asked to see how their documentation stood up to expectations.

When these providers look over what has been requested, they often see that the documentation is insufficient to support billing the service, or that there is a glaring lack of proper case management. Instead of clearly defined episodes of care, there are ongoing treatment plans that have been billed as active, medically necessary but based on frequency and/or duration alone, they are not.

Missed Errors Can Cost You

Mismanaged episodes of care along with error-riddled and/or incomplete documentation can cost you in more ways than one. Not only can these issues make you susceptible to recoupment, but they can also affect your future reimbursement from third-party payers and put your license at risk.

An internal audit for documentation can help determine if:

• Risks are appropriately identified and managed
• Billing, coding, documentation, and other financial and operational information is accurate, reliable, and timely
• Employees act in compliance with policies, standards, procedures, and applicable laws and regulations
• Internal standard operating procedural programs, plans, and objectives are achieved
• Quality and continuous improvement are incorporated in the practice’s recordkeeping process
• Significant regulatory issues affecting the practice, such as documentation requirements and other Medicare standards, are recognized and addressed.

Review your Documentation Regularly

Internal audit responsibilities require a system and schedule to review your documentation regularly. As you review your documentation, begin with an initial audit — generally called a baseline audit — of your documentation before any compliance programs are put into place. From this baseline audit, derive a list of significant goals for improvement and a schedule to achieve those goals.

When auditing your chiropractic documentation, it’s reasonable to begin by looking at Medicare guidelines. Medicare has set forth the documentation required in initial and routine office visits. Measure yourself against these standards as you review files from each payer class.

The Risks of Not Self-Auditing are High

This process, although time consuming, is important and necessary. The risks of not self-auditing are high. Insurance carriers routinely file complaints with examining boards when a doctor’s documentation doesn’t meet their contract’s requirements. And those complaints would mean that any state board of chiropractic examiners, including yours, would be required to investigate the allegation.

Don’t find out the hard way that your documentation, coding, and billing are setting off red flags. Set up a regular schedule for internal documentation audits and find the trouble spots before an outside auditor does. Need more assistance? Give us a call at (855) 832-6562 OR schedule a Proactive Chart Review today to start your internal audit now!

Dr. Colleen Auchenbach graduated with a Doctor of Chiropractic from Cleveland University Kansas City in December of 1998 and practiced for over 20 years. Her interest in Medical Compliance began when she earned the 100-hour Insurance Consultant/Peer Review certification from Logan University in 2015. She has been a certified Medical Compliance Specialist-Physician since 2016. In November 2020, Dr. Auchenbach joined the excellent team at KMC University as a Specialist and as part of this dedicated team is determined to bring you accurate, current, reliable information. You may reach her by email at info@kmcuniversity or by calling (855) 832-6562.