Physicians Practice - March 2008 - (Page 77)

CME THE LAW AUDITS 101 B Y R O B E R T A N T H O N Y, B A HOW TO HANDLE (AND AVOID) A PAYER INVESTIGATION There is one word that can elicit groans, inspire fear, and unleash migraines in grown adults just by its very mention. Audit. Every practice worries about the possibility of an audit, whether by Medicare or a private payer. The sad truth, however, is that few physicians know what to do when an audit actually occurs. If an audit comes to your practice, should you be worried? Absolutely, says Tom Powell, senior consultant for Healthcare Administrative Partners, LLC, in Media, Penn. “When an auditor comes to visit, despite what they say or how they behave, they’re there for one reason: They believe you are doing something wrong.” No matter how you look at it, an audit is a serious matter. If your practice is going to survive the process, it needs to be prepared. We’ve asked a panel of experts for the best approach to surviving — and even avoiding — a Medicare or private payer audit. WHY ME? While there are some who argue that audits help protect against LEARNING OBJECTIVES After reading this article, readers will be able to: • List behaviors that may trigger an audit from Medicare or a private payer. • Determine what course of action to take if an insurance payer sends a letter initiating an audit. and avoiding audits. • Identify best practices for handling WWW.PHYSICIANSPRACTICE.COM and eliminate fraud, Douglas M. Nadjari, a partner with Kern Augustine Conroy & Schoppmann, a Lake Success, N.Y. law ﬁrm that caters primarily to healthcare professionals, takes a less charitable view of the auditing process. “It is a way for the insurance companies to balance their books,” says Nadjari. “It is not about quality assurance. It is about ﬁnding a way to nickel and dime not every physician, but many physicians so that they can try to maximize their proﬁt.” Not surprisingly, most audits focus on billing and coding practices. Whether it’s Medicare or a third-party insurance company performing the audit, chances are good that it’s the practice’s recordkeeping that will be scrutinized. For that reason alone, it’s important that everyone in your practice keep patient records organized and comprehensive. The ﬁrst questions an auditor will be looking to answer are: • Do the consult notes support the patient diagnosis? • Was the service provided medically necessary? • Was the service appropriately coded? If your patient records demonstrate all of the above, then you’re already halfway to surviving an audit. However, if your records don’t answer these questions, don’t even consider altering or falsifying MARCH 2008 | PHYSICIANS PRACTICE | 77 http://WWW.PHYSICIANSPRACTICE.COM

Table of Contents Feed for the Digital Edition of Physicians Practice - March 2008

Physicians Practice - March 2008 Contents The Bigger Picture: Try a Little Tenderness Second Opinion Letters Physicians Practice Pearls: The Value of First Impressions Noteworthy Cover Story: Your Complete Guide to Patient Service Billings & Collections: Rules to Code By The Administrators Desk: Selecting an EMR Technology: Learn to Love Your Nerd Ask The Experts Coding The Guide The Tech Doctor: All About Blogs The Great Practice Makeover: When Bad Things Happen to Good Practices Start It Up - NEW! The Law: Audits 101 In Practice: Do As I Say... Pretty Please? Healthonomics: Handling the Changes Wrought by Medicare D Classifieds Advertiser Index

Physicians Practice - March 2008

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