Pay attention to this coding hotspot quintet to minimize audit chances.
Most medical practices live in fear of the audit. Even with the most robust policies in place, there’s always that feeling that the practice could be doing more in case a payer wants to check your books.
Luckily, you can count on advice from experts like Frank Cohen, MPA, MBB, principal and senior analyst for The Frank Cohen Group in Clearwater, Fla.
Check out what Cohen had to say about can spark an audit in his January 7 Webinar, “Is Your Practice a Government Target? Pre-Audit Risk Analysis.”
Cohen reports that an audit is a review of medical claims, and the auditor could be either a government or a private payer. A payer might opt to audit your practice for several reasons; a random event that created an anomaly in your coding/billing, a benchmarking event, etc.
In all actuality, however, “it may be impossible to determine what triggered an audit,” says Cohen. “But you must always be prepared for one.”
According to Cohen, payers decide to audit most frequently due to concerns in the following areas, which he defined as “The Big 5”:
Best bet: Be sure to keep compliant with all payer rules on all issues — but take extra care to ensure that you have no compliance holes in Cohen’s aforementioned “Big 5” areas.
Within Cohen’s “Big 5” of audit hotspots, there are several specific missteps that could drive auditors to your front door. According to Cohen, practices are frequently penalized for these reasons: