Identifying Risk: Healthcare Audits & More for ENT Practices

ENT Healthcare Audits and ReviewsWhen it comes to ENT account management, it is important to stay on top of your medical practice or clinic by performing your own reviews and audits. If you are able to identify and correct potential issues before they become a big problem, you will save yourself a lot of time, money and stress. Working with a professional consultant to implement a compliance program can help you to optimize the payments that you collect from patients, reduce common billing mistakes, lower your chance of getting a healthcare audit, avoid liabilities with health information breaches, and prevent other types of conflicts.

There are tools that ENT practice owners and managers can use to their advantage. Professional services like MD Pro Solutions provide assistance in the performance of an annual fee schedule review, offside CPA audits and other check-points that you can use to help fine-tune your ENT account management, billing and coding. We can also provide your team with online coding help and support, as needed, along with training and credentialing too. We specialize in otolaryngology, which allows us to be better equipped to help you and your staff maximize your earning potential and ensure that you are operating to the best of your ability.

Identifying Issues and Potential Problems
The first step in taking control of your ENT account management is to identify any issues, problems or vulnerabilities in your existing system. According to the Office of the Inspector General (OIG) for the United States of America, coding and billing has been identified as a potential risk area for physician practices. While these are necessary services, it is more important now than ever before to stay on top of this department with regular healthcare audits, training, support and other “temperature taking” measures.

Some of the areas that are considered to be the most at-risk include secondary insurance submissions, patient statements, explanation of benefits, denials, legibility, patient identification, copying and pasting, improper use of modifiers, HIPAA security and privacy, financial agreements, contracts, and much more. These are all things that we use in ENT account management each and every day. Specific areas in billing and coding, such as the date of service, place of service and chief complaint, are often pitfalls for practices, as just a simple mistake or error can cause big problems.

Are You At-Risk for an Audit?
Work with healthcare consulting companies like MD Pro Solutions to perform regular healthcare audits and benchmark your data to determine whether any of your practices put you at-risk for a formal audit. Performing your own annual fee schedule review and offside CPA audits can help you paint a comprehensive picture of how well your practice is performing and put aside any fears about being at-risk for an audit. Identifying whether any of your providers are outliers who have billing patterns that make them stand out from the crowd can help. It is important to make sure that all of the billed services are accurately and properly coded and documented. Everything must be verified to avoid issues down the line.

With multiple providers in your practice or clinic, it is important to monitor productivity to determine which of those providers is at the highest risk for a healthcare audit. Compliance programs and other tools can be used to make changes that will reduce the risk and hopefully stop the problem from occurring in the future. Those tools can include training and education, adding new policies and procedures for the practice, as well as internal auditing of your ENT account management programs. An internal healthcare audit can help you stay on track to reduce potential over-payments or possible false claims, which can result in penalties and bigger problems.

What to Expect from Audits
When you perform a healthcare audit within your own practice, you can determine that the bills are being coded accurately and that the services provided in the medical records are also accurate. They can also help you determine if the documentation provided by providers is being completed correctly and legibly. You will also be able to see whether the services or items that are provided are necessary and reasonable, as well as be able to identify whether any incentives exist for performing unnecessary services. It is a difficult, yet important part of ENT account management, and it should be done regularly to protect your practice.

MD Pro Solutions works with your front desk staff and billing team to improve education and knowledge of medical billing and coding to ensure that you are getting paid for the work that you do. Our goal is to optimize your coding system so you can maximize your earning potential while protecting your practice at the same time from fraud or billing inaccuracies. Give us a call at 508-946-1665 to schedule a FREE initial consultation or to learn more about our options for auditing and reviews, credentialing services and other ENT account management opportunities.