Make Coders First Line of Self-Audit Defense

Posted on 16 Feb, 2016 |comments_icon 3|By Chris Boucher

Self-auditing should occur at least annually, experts say.

If you want your coding to be bulletproof, your practice should invest in regular self-audits.

Why? If you conduct self-audits regularly, you reduce the risk of a payer audit. Self-audit carefully, and you can fix coding problems before they get bigger.

“It is easier to fix a drip before it becomes a raging torrent,” reminds Steven M. Verno, CMBSI, CHCSI, CMSCS, CEMCS, CPM-MCS, CHM, SSDD, a coding, billing and practice management consultant in central Florida.

Fix those drips by knowing where and when to perform self-audits with this advice from the experts.

Schedule Self-Audits Annually, at Minimum 

Expert opinions vary on how often you should perform a self-audit; your self-audit frequency will depend on practice resources and other mitigating factors. No matter the practice’s individual situation, however, experts recommend that you perform audits at least annually to ensure compliance.

Although you should perform audits at least yearly, “you may want to do it more often,” says Suzan (Berman) Hauptman, MPM, CPC, CEMC, CEDC, senior principal of ACE Med, a medical auditing, coding and education organization in Pittsburgh, Pa. The number of self-audits could depend on anything anything from practice size to the introduction of new treatments. And it needn’t be permanent; you might want to conduct self-audits more regularly for a brief period, and then return to a six-month or one-year self-audit gap.

Read Also: Keep Practice out of Auditor Targets by Knowing These Triggers

Examples: Let’s say your practice just started providing a new procedure, or offering a new service. “It’s important to audit that service at the beginning, perhaps every 90 days for a period of time,” Hauptman says. Or if you hire a new physician, the practice should audit him “after 30 days, and then again after about 90 or 120,” she advises.

If your practice has the infrastructure, you might conduct self-audits by claim, according to Verno. He offers the example of a practice that “performed an audit weekly, and brought issues to the managers and provider at every Friday meeting.”

Try this: Tailor your self-audits to your practice’s needs. Also, ask coding and billing managers to keep everyone posted about any changes to coding and billing practices or procedures. That way, the practice can introduce temporary self-audits on a need-to-have basis.

Use Coders for Self-Audits Time Permitting

To flag down any compliance issues, everyone involved in coding and billing should be on alert for potential problems, Verno says. “Every employee should be tasked to look for red flags to indicate a potential problem. Problems should be brought to the attention of a designated manager,” he says. If you want to go this route, be sure to appoint a compliance manager who is charged with investigating reports of “red flags.”

When it comes down to who should perform the self-audits, options vary. Coders could perform them if they aren’t the one that coded the claim initially, Hauptman says. But use caution, because “you don’t want to have someone audit their own work,” she adds. Also, you don’t want to add too much burden on the coders you’ll be asking to do the self-audits.

If you don’t have enough coders to successfully self-audit the work in-house, Hauptman recommends that you hire an outside auditor, “or have someone in the office who is aware of coding” perform the self-audit.


Chris Boucher

Chris Boucher has nearly 10 years of experience writing various newsletters and other products for The Coding Institute. His blog will cover several areas of coding and compliance, including CPT® coding, modifiers, HIPAA compliance and ICD-10 coding.

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