Chart Auditing: Are You Billing What You Should?

A simple medical chart audit can save your practice a lot of money.

There are a number of mistakes that can occur in a practice on any day:

•    Someone forgets to charge for CLIA-waived lab tests, although the supplier charged for the test kits
•    A patient was injected with 10 units of a drug, but only one unit was billed for.
•    Three minor surgical procedures were performed, but they were not noted on the encounter form.

These are mistakes that happen and they can be very costly. Repeatedly making the mistakes or forgetting to bill for services could cost in the tens of thousands of dollars throughout the year.

A simple chart audit by a professional chart auditing service can solve these issues, as well as other costly problems.

What Will A Chart Audit Change?

There are four things that a chart audit will help you understand better. Those things are:

• How the charges for all services are captured
• How well the staff follows up on claim denials
• Whether charge entry, code selection, claims submissions, and payment processes are correct.
• The cause of any of the aforementioned problems.

While some chart audits are simple, others are more complex and that is why there are many practices that choose to hire consultants. By having an outside perspective on the situation, mistakes can be more easily identified and unique ideas can be presented in the situation.

Before the audit begins, the physicians and the practice and the office manager should identify areas that create a great deal of concern. For instance, do most of the denials seem to come from one payer? Does one doctor seem to generate less revenue that the others in the practice? Maybe you simply need to have a better idea of how the practice is performing as a whole. Discussing these matters with the medical chart audit service will help bring a great deal of focus to the situation.

The Collection and Analysis of Data

Once the areas of focus are identified, it is time to begin the collection of data. A certain day should be chosen to do the review and that day should be a typical office day that occurred at least 90 days ago. This increases the likelihood that almost all of the charges have been paid, allowing for the review of denials, appeals, and follow-up work.

A patient list can then be printed from that day’s appointment schedule and the superbills from that day pulled. Account details for patients treated on that day should be reviewed and their charts pulled. The Chart auditing service then uses a form that they can record pertinent data in so that it can be properly analyzed. If all or part of a claim was denied or if the payment amount seems lower than what the fee schedule amounts says it should be, then the explanation of benefits will need to be consulted. The codes on superbills will need to be compared with diagnostic codes so that any discrepancies can be noted. Those discrepancies will need to be summarized, identifying the dollar amounts of unbilled charges that should have been charged and paid.

From here, the practice is then able to act on the findings so that money can be collected. Of course, each individual situation will need to be evaluated because a patient may have been informed that their charge was a certain amount and that they were paid in full, but they could be extremely unsatisfied, upset, and ready to change physicians if they are told they were underbilled and owe more. The proper way to deal with each case will need to be discussed. It is typically very important to consider patient satisfaction since losing a patient over a billing issue could result in a lot more revenue lost.

Acting On Your Findings

When acting on findings, it is best to look at the denials that the office can prevent. Denials may be due to patient eligibility status, coding errors, and submitting claims past their filing deadlines. These are matters that can be addressed so that they do not happen again in the future. You can learn about why they are happening so that new rules can be put in place to avoid them. This is also an opportunity to uncover fraud, which means the practice’s compliance plan will need to be reviewed so that future fraud can be prevented.

 

If your practice is ready to have a medical chart audit that shows how you are doing and/or addresses some concerns that you have, MD Pro Solutions can do that audit for you. Our knowledge and fresh perspective will help you identify issues so you can save money rather than lose it. To learn more about our chart auditing service, call us at 508-946-1665 or fill out our contact form.