Documentation Tips for Reducing Risk of Audits and Lower Reimbursement

Audits can be a painful part of the daily practice routine even for the best chiropractic teams. An oversight or omission could lead to massive fines and penalties that could have a significant impact on your business. Additionally, all claims your business submits are subject to rigorous prepayment reviews or post-payment audits.
 
Protecting yourself requires ensuring the best practices and looking at things from the other viewpoint. Here are some suggestions that can make a significant difference.
 
 1. Know How Auditors Operate
 
Audit provides the framework to improve the quality of patient care in a collaborative and systematic way. Through Audit we can identify emerging trends, which enables us to identify risks and implement actions before it becomes a bigger issue.
 
If you know how auditors operate, you will know the key aspects where to improve your billing practices. Ensure to learn from audits and review data thoroughly. Scrutinize data to ensure gaining all that you can from it and move forward making the necessary changes to support best practice
 
Using this document is your way of seeing inside the audit process and knowing which practice areas are scrutinized. You’ll then be better equipped to ensure that your documentation makes the grade. You can also review the Medicare Program Integrity Manual for more insight into how auditors work.
 
2.    Always Prepare Accurate Documentation
 
Accuracy encompasses all forms of information oversight: patient identification, amendments and corrections to records, validation of author, plus auditing for document validity before sending out as part of a claim for payment. Knowing that multiple systems will probably be involved in an audit, all data should be documented, including meaningful use, reports generated by the practice’s EHR system, and other evidence supporting medical decisions.
 
Procedures that are more likely to be scrutinized are sleep studies, outpatient physical therapy and MRI’s, which the Office of Inspector General (OIG) believes may be overused and are among the OIG/RAC targets requiring careful documentation.
 
3. Review Key Qualifiers 

Every claim should clear internal quality checks before submission. Be sure the service you provided to the patient:

• was medically necessary.
• was meticulously dated at every visit- from initial treatment onwards.
• has accurate patient identifier information.
• was coded correctly in terms of diagnosis, evaluation, and management, and modifiers did not violate any regulations or statutes.
• met all coverage rules.
• was correctly and accurately billed for the service provided.

 
4. Use Correct Midwifery Billing Software

The right computer program can catch errors that are the result of human error. In addition, there is a plethora of available software that practices can use to streamline their documentation and reduce audit risks across the board.
 
Many of these solutions are cloud-based, which is a great advantage. It means you’re always running the most up-to-date software to help keep your compliance current and that your valuable documentation data is being continuously backed up off-site.
 
5. Review Audit Risk to Lower Reimbursement  

As more prepayment and health plan audits emerge in the healthcare landscape, hospitals can use them as new opportunities for cost savings in audit management, record request responsiveness, and health plan collaboration. Many providers have found some principles ways to use audit storms to strengthen operational processes and mitigate reimbursement losses.

6.    Plan for the Worst-case Scenario

As the saying goes, “prepare for the worst and hope for the best.” Most audits are triggered due to a history of non-compliance or related past problems; however, more practices are being randomly audited, even with no apparent violations or errors.

7.    Be proactive
 
Hope alone will not prevent an audit nor ensure that your practice passes one. If your practice is audited at random, having all of your documentation complete, accurate and fully compliant is the only way to be confident that your practice won’t be caught off guard and that if audited, the results will be favorable.

8.    Experienced Medical Billing Service Provider Part of Your Team

As Midwives, your biggest priority is caring for your clients, and getting you compensated for your hard work is ours. Midwives need every advantage when navigating the complex world of insurance claims. Our role during this process is to connect your practice and insurance seamlessly. We act as the back office that manages administrative duties so that you can focus on your passions, mamas, and their babies.
 
We provide straightforward, affordable solutions that streamline the insurance process and get you paid. Our office employs certified coders, medical compliance officers, and practice management professionals to implement protocols that bring you the most valuable payout. We are certified in HIPAA requirements, ethics, and practice management so you can entrust us with your clients' information
 
References
Documentation tips that reduce audit risks. ChiroHealthUSA. (n.d.). Retrieved September 28, 2022, from https://www.chirohealthusa.com/member-providers/documentation-tips-that-reduce-audit-risks/
5 documentation tips to reduce RAC audit risk. Coronis. (n.d.). Retrieved September 28, 2022, from https://www.coronishealth.com/blog/5-documentation-tips-to-reduce-rac-audit-risk/