Fix My Practice – Oh No! Is Your Practice Being Audited?
The Physicians Practice S.O.S. Group® www.ppsosgroup.com
Should we panic when we receive that official letter in the mail informing us of an impending medical records audit? What should we do next?
We should start with building a good defense and reviewing the top five pitfalls
1.) Not responding to the audit request.
- Take the time to read the letter carefully.
- If there is something that is not clear or not understood, call the contact person and ask questions.
2.) Incomplete medical records or progress notes
- Only send the specific records that are being requested in the letter.
- Review records to be sure that the patient’s name, date of birth, date of service is on each page.
3.) Being Unprepared
- Fraud, Abuse and Waste is the primary focus, so audits should not come as a surprise to any of us.
- Develop a plan or process for your office of how records are to be kept and verified along with the billed services.
- Perform periodic internal audits.
- Your efforts should be documented as part of the compliance plan.
4.) The outcome should be reviewed
- Avoid unnecessary trouble by reviewing the letter and taking into consideration the advice within the letter.
- Read the letter/report in detail.
- The goal is to avoid repeated mistakes, so it would be advantageous to look for anything that would be helpful to our practice.
- Inform the staff and physicians of the audit results.
5.) Illegible medical records, (*if you are still writing out notes)
- Keep in mind that if the auditor cannot read the medical record it cannot be audited.
- The physician’s signature must be legible as well.
- NOTE: perform a legibility test if notes are still hand-written.
Lastly, a good defense is always a good offense. When was the last time you had a baseline audit done? If it has been over a year, then you should consider having a baseline audit done. Many providers think because they are on EMR they are fine but in fact over 75% of all templates are incorrectly set up.
Regina Mixon Bates, CEO | The Physicians Practice S.O.S. Group | www.ppsosgroup.com
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