In the current regulatory environment, it is likely for hospitals to undergo a federal audit. There are a number of compliance activities hospitals can undertake to protect and survive a federal audit. The takeaway points that rheumatology practices should embrace in day-to-day practice are:
Clinical documentation improvement—When a provider submits a claim for reimbursement, the provider is stating that the medical documentation in the patient’s record supports the claim billed. Therefore, providers should verify that the documentation on file supports the claim when questions or doubts arise. Practices must come to terms with the fact that the coding is only as good as the documentation. Thus, the practice staff must ensure documentation is accurate, complete and stored appropriately.
Increased federal audits have created an environment of fear; providers and coders are often overly cautious about incorrectly coding, which opens the door to undercoding to avoid inadvertent overpayments. This fear is understandable, but practices must focus on coding and billing out every claim correctly the first time. Providers must ensure that services and procedures rendered to patients are coded accurately and the documentation supports the claim.
Be proactive—Do not wait for a federal auditor to knock on your door before assessing and fixing the organization’s risk areas. Weaknesses should be identified and improved upon continually. Practices should consider the following questions when assessing risk: 1) Is there a high turnover rate of billers and coders in the practice? 2) When was the last compliance training related to coding and billing conducted? 3) Have we provided regular compliance training to the providers concerning medical documentation?
Educate, educate, educate—Compliance education should be a priority for every physician practice. Practice administrators and physician managers should provide regular education for their physicians and coding and billing personnel on the importance of medical documentation and the submission of accurate claims to payers.
If you aren’t sure if you are undercoding or for questions about coding and compliance, contact the ACR certified coding and auditing staff at [email protected] to learn how they can help with audit reviews and training for you and your staff.
