Medical Chart Audits: How much Money is Your Practice Losing?

Medical chart auditOne big question that practices ask themselves is whether or not they are truly billing what they should.

What is surprising is that a simple review of how charts are kept can save a great deal of money. Here are some common mistakes:

•    Forgetting to charge for CLIA-waived lab tests, although the supplier charged for the test kits.
•    Injecting a patient with 10 units of a medication, but only billing for one unit.
•    Forgetting to note minor procedures on the encounter form.

These are mistakes that can be costly and repeatedly forgetting them could cost tens of thousands of dollars when it is all said and done.

Through a simple chart audit, you can fix many of the issues that become costly.
Benefits of a Chart Audit

The benefits of a chart audit are plenty. You obtain a better understanding of:

•    How well you capture the charges for the services performed
•    How well your staff follows up on claims that have been denied
•    Whether the code selected, claims submission, charge entry, and payment processes are accurately carried out

Once the problem is identified, the cause of the problem is found so it can be rectified.

The Process

Before the chart audit begins, it is good for all physicians in the practice and the office manager to express areas that concern them. Do most of the denials seem to come from a single payer? Is there a physician in the practice who generates less revenue than the others? Maybe you just want to know how the practice is performing as a whole. You can discuss these issues with your medical chart auditor so that focus can be brought to the audit process.

Next, you will collect information so it can be analyzed. The data that is collected depends on the areas of concern. A day from approximately 90 days ago will be chosen to conduct the audit. A patient list is then printed from that day’s appointment schedule, the superbills for the day are pulled, patient account details are pulled just for that day, charts are pulled for that day, and the explanation of benefits is consulted for claims that were denied or paid below the schedule amount, compare the diagnosis codes on the patient account with what is on the superbill, outline the discrepancies, and then address those discrepancies. If there were any out-of-office procedures that day, they need to be considered separately.

Take Action

After the medical chart auditor shows you their findings, it is time to act on what is found. This is where you will truly see the benefits of a chart audit.

What you will see is that there are denials that can be prevented by the office. By checking patient eligibility, a great number of denials can be prevented and alternative treatments that they do cover can be implemented. If there are no alternative treatments, then the patient can be informed so that they can make an educated decision on what they want to do.

Another reason for denials is the coding error. Coding errors can be quite costly. If you find recurring issues with denials, it is a must to address that problem so they stop. However, there are times that denials are due to incorrect processing by the insurance company. When that is the case, customer service needs to be contacted so the issue is addressed. If it is not addressed, the alternative is losing money that could be recovered by simply calling the insurance company out on their error.

Revealing Fraud

There are times when a medical chart audit will uncover fraud. When that’s the case, the first thing that needs to be done is a review of the compliance policy that is already in place at the practice. This will ensure that everyone knows procedure and that fraud can be properly identified. When fraud is identified, it stops and that means the practice saves more money, as well as its reputation.

Medical Chart Audits are Worth it

All in all, medical chart audits are worth it. You are able to assess the business as a whole, the physician partners, and the staff that has the practice in their hands. Having a medical chart auditor give you that outside perspective is going to be worth your while as well.


If you are not sure how much money you are using from charting errors, MD Pro Solutions can help you by auditing your charts and advising you of the issues and the ways to rectify them. To learn more about our services, call us at 508-946-1665 or complete our contact form and someone from our office will get back to you.