Audits Should Not Be Scary


It was the best of times, it was the worst of times. That is
how some people think when they hear the word, “audit.” Everything is going
great and then an audit comes around and ruins everything! We’ve all thought
that way once in a while.

Audits are actually a good thing. When you have regular
internal and external coding audits, you actually prevent even scarier ordeals
from happening. Ignorance is bliss until your ignorance gets you in trouble. You
want insurance companies to pay you for your work. You don’t want to pay them
for fines that could have been avoided.

How do we keep our patients and the insurance companies
happy? What is the difference between internal and external coding audits? How
often should we do them? Are they mandatory?

Coding audits show us what we are missing. They show us our
blind spots. Hard work and doing your best are not excuses for doing something
incorrectly. Coding audits are not mandatory, but the most successful practices
are doing them regularly to maintain integrity.

Internal coding audits are done within the practice to make
sure everything is up to date and in compliance with the everchanging rules and
regulations. Some practices have a full-time internal auditor on staff and the
larger hospitals even have whole departments dedicated to internal coding
audits. However it is handled, it is worth the time and effort to prevent more
expensive and time-consuming problems down the road.

Certain staff members need to be properly trained in how to
perform coding audits. If you do not have a full-time auditor on staff, you
need to make sure the staff members who are doing the audits are not distracted
with too many other jobs while doing the audit. This will prevent mistakes and
will give them the focus they need to do the job right. These should be done
annually at a minimum.

External coding audits are performed by someone outside of
the practice. This is a great objective resource as this person or organization
has nothing to gain by the results of the audit. Fresh eyes are also great
resources to finding possible problems that you may miss when you see them
every day.

External coding audits are important because the results are
more attractive to insurance companies, other providers and stakeholders.
External coding audits review everything from E/M services to office and
surgical procedures. These should be done quarterly, biannually or annually.

You do not want to be in a vulnerable position. Contact MPS
today on how to get started with internal and external coding audits. We can help
make sure all of your hard work get the credit and payment you deserve.