Physician's Practice - November 2008 - (Page 68)

CME THE LAW just show up unannounced at the door. Legitimate audits start with a letter that clearly divulges who is asking. Just review the letter then ask simple questions and conﬁrm the payer indeed deputized any thirdMost auditors “aren’t going on a safari where they are looking at hundreds and hundreds of charts,” says Judy Bee, a consultant with Practice Performance Group in La Jolla, Calif. In Bee’s experience, auditors Generally speaking, don’t be surprised or overly concerned if a thirdparty representative sends you a note, says attorney Sidney Welch with Atlanta-based law ﬁrm Arnall Golden Gregory, noting the increase in outsourcing. Both Hausfeld and D’Souza agree with Welch, saying that most payers do contract with an outside source, which therefore grants the third-party with proper authority. Still, shady shenanigans do happen occasionally, so be on the lookout. Here are some tell-tale signs that what you’re facing may be offkilter or particularly odious, and that you should grab a lawyer: • Auditors at the door — Most audits RAID “I am itching for a fight; I would love to squish these guys like a cockroach.” usually will specify what they want to see, such as 10 examples of a 99215 or some routine, general sampling. If the request does seem more random, you certainly can limit your chart pulls to patients insured by the payer in question, she adds. Arvind Cavale, MD party organizations. Have the letter-sender fax something showing its authority and get all pertinent e-mails and phone numbers. Whether the audit targets one patient or a handful, look for who insures those patients. You can also call the payer directly, as Cavale did, to make sure they’ve engaged the organization as a legal agent. Still worried? Call your local medical society or even a lawyer if the inquiry seems especially far-fetched or vague. Also, an auditing group should send a business associates agreement for you to sign, as required by HIPAA, says Rohan D’Souza, founder of D’Souza and Associates, a billing and consulting company in Hockessin, Del. are initiated via letter. If an auditor actually comes to your door and wants to see some charts now, he probably suspects you’ll alter records if given a chance. They are after something serious. READY TO WIN Does the thought of audits make you sweat? There’s nothing like being prepared to help keep you cool. Here are some quick tips for making sure you are ready for any eventuality: • Audit yourself — Before someone else points out your mistakes, ﬁnd them yourself. Many practices conduct prospective audits once a year, inviting in a coding expert to review a sampling of charts and claims before they go out. The auditor can pin down problems and teach you how to do better in exactly the areas where you are messing up. IN SUMMARY Third-party audits are on the rise. Here’s how to respond: different presenting problems, lay out each one this way: diagnosis, status, and treatment or prescription. Don’t record the problems presented and then list medication changes that aren’t necessarily linked to the management of those problems. Instead, for each problem, clearly link your diagnosis, status, and treatment; this illustrates the disease management payers look for. • Conﬁrm that the auditor has the • Write right — Look at a note you wrote three years ago. Can you still understand what you meant? Would anyone else? If you keep paper charts, legibility is a must. authority to do an audit by asking for proof from the auditing party or the deputizing payer. of your payers regarding third-party audits as well as norms about how often audits can happen, how they happen, and what you are required to do. smoothly and most third-party requests are authorized. • Hands off — Once an audit letter comes in, you may feel tempted to review your charts and make some minor alterations to make them more clear or more accurate. Don’t do this. In fact, don’t even think about doing it. Auditors are trained to spot such modiﬁcations, and even if what you changed doesn’t affect the overall meaning of the note, such corrections will cast suspicion upon you — not what you want. Just send what you have. • Check the policies and procedures • Be orderly — An auditor isn’t likely to pore over your notes to uncover mysteries; he simply doesn’t have the time, and so will submit his best educated guess if you’re not clear. So make every effort to delineate exactly why you did what you did. For example, when documenting a patient’s • Don’t panic. Many audits go 68 | PHYSICIANS PRACTICE | NOVEMBER 2008 WWW.PHYSICIANSPRACTICE.COM http://WWW.PHYSICIANSPRACTICE.COM

Table of Contents Feed for the Digital Edition of Physician's Practice - November 2008

Physician's Practice - November 2008 Contents Death of Solo Practice Just a Myth Letters HSAy What? Noteworthy Finding Lost Revenue: The Search for Billing and Coding Gold Getting More: Our Annual Physician Compensation Survey ’Tis the Season to be Neutral Ask the Experts Evaluating Paperless Labs HR in a Box? The Guide Coding Third-Party Audits on the Rise Branding the Cash-Only Practice Intra-Office Tug-of-Wars Stickin‘ Up For Yourself Classifieds Advertiser Index

Physician's Practice - November 2008

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