While chart audits can seem like a low priority in today’s hectic medical practice environment, an annual review can identify potential risk issues before they develop into serious complications. Not sure if now is the right time for a third-party audit? Here are four signs that indicate you need an audit of your coding, billing, and clinical documentation.
Signs You Need a Medical Coding Audit
Medical coding audits can be time-consuming, but they’re essential tools that safeguard your practice’s financial health and ensure regulatory compliance. By identifying potential issues early, audits protect your revenue and ensure that you’re delivering the best possible care to your patients. Here are some key signs that indicate your practice might need one.
1. It’s been more than a year since your last audit
While many organizations opt for more frequent chart audits, an annual review is the minimum expectation per the OIG. If it’s been over a year since your last audit, it’s time to take action. The Office of Inspector General expects you to conduct an annual review to detect potential issues as regulations emerge. For example, CPT codes are updated yearly, making regular audits essential to minimize the potential for errors.
Audits can reveal areas where your practice is missing revenue opportunities or where clinical documentation could be improved. By partnering with auditing experts, you’re not just supporting regulatory compliance – you’re optimizing your practice’s financial performance.
We know you’re focused on providing excellent patient care, but it’s also crucial to work on your own business. By conducting a medical coding audit every year, you’re ensuring your practice stays up-to-date and financially strong. Although conducting a yearly audit doesn’t change the likelihood of being audited by an outside entity, it significantly helps you prepare if a third-party audit does occur.
2. You’re not using an external auditor
Using an external auditor for your medical coding audit ensures that you are getting an independent perspective from coding professionals familiar with trends and issues in your specialty.
An external auditor offers peace of mind by:
- Providing an independent perspective
- Confirming what’s going well
- Identifying potential revenue opportunities
An action plan from an outside party provides your practice with an unbiased roadmap to ensure revenue integrity.
3. You want extra support staying compliant
Partnering with an external auditor who specializes in medical coding provides an objective review of your third-party claims and the supporting records. This helps to identify inadvertent billing errors and reduce the likelihood of an adverse third-party audit. An internal auditor, while valuable, may be stretched thin with other responsibilities and might not have time to perform a deep dive into relevant trends and regulatory issues.
Expert external auditors help support robust auditing and monitoring as part of your compliance program. They bring a neutral point of view, leveraging their expertise from reviewing multiple practices with diverse perspectives to translate that wisdom to your practice. This expertise allows them to navigate the complex regulatory healthcare landscape, addressing potential issues before they lead to serious consequences.
4. You want to invest in your people
Your coding staff is an integral part of your practice, and their expertise directly impacts success. Medical coding audits are not just about identifying errors; they’re valuable tools for staff development. Audit findings can pinpoint areas where your team might benefit from additional training or professional development.
This proactive approach not only improves coding accuracy but also boosts staff confidence and job satisfaction. At Compass Healthcare Consulting, we are your trusted partner for a comprehensive coding audit. Not only can we help you plan for future audits, but we can also assist in effectively responding to an unexpected one.
You Need To Assess Risk and Forecast Future Revenue in Due Diligence as an Investor
Audits are not just part of a practice compliance program. When considering the merger and acquisition of a medical practice, conducting a medical coding audit is a critical step in fulfilling due diligence. The acquiring organization assumes responsibility and liability for the practice going forward, making it essential to identify any potential issues beforehand.
A thorough audit can uncover coding inaccuracies or compliance concerns, allowing these to be addressed before finalizing the deal. This protects you as the buyer from unforeseen liabilities and ensures that future revenue issues are accurate.
Choose Compass To Guide Your Medical Coding Audits
Compass Healthcare Consulting stands out with its team of certified coding professionals who deliver value far beyond typical audits. As industry veterans, we offer a virtual-based team with flexible bandwidth for nationwide service.
Our expertise spans various specialties such as:
- Dermatology
- Pediatrics
- Primary Care
- Ophthalmology
- and more
Compass provides practical, actionable solutions tailored to your unique needs. With our comprehensive approach to risk assessment, compliance support, and clinical documentation improvement, Compass empowers you to navigate the complex healthcare landscape confidently, ensuring your practice thrives in today’s challenging environment.
At Compass, we understand the complexities of managing a medical practice. Regular medical coding audits are crucial for maintaining compliance, optimizing revenue, and improving staff performance. Whether it’s been over a year since your last audit, you need an external perspective, or you’re considering a practice acquisition, timely audits are essential. Let us guide you through this vital process so your practice thrives in today’s healthcare landscape.
