Value of Internal Audit Reviews

Many organizations and practices alike are concerned about the documentation and coding trends of their providers. Oftentimes, the obstacle to performing an internal review to diagnose concerns is of course the expense involved. However, this should be seen as an investment or an insurance policy for your organization.

What value can an audit and review with DoctorsManagement provide?

• Over-coded vs. Under-documented: Over-coded has become a buzzworthy term in compliance, but one that our team uses with caution due to the implications it bears. What is noteworthy is that typically the medical necessity of the service, under review, supports the level of service, however, the audited complexity is under-documented. The DM team works providers on ways to efficiently and effectively communicate this through the documentation of each service.
• Under-billing: Many providers are unsure of what level to choose, and therefore they reason it may be better to level down in their code selection. There is no need to teach providers how to choose a 2,3,4, and 5. Using their own coding patterns, the national trends per specialty, and their audit review findings, we can teach them how to choose their codes more specifically. Providers are not tasked with under or over coding- but rather with CORRECT coding.
• Services Under Utilized: If an audit sample is comprehensive in nature, it will sample all service lines of a provider. While evaluating these service lines it opens the door for consideration of services that may have been under utilizes as well.
• Identify Compliance Concerns: It is our hope that an audit review finds zero compliance risk for your organization, but at the end of the day, the goal of an audit is absolutely to find risk. So, be comfortable knowing that is our job going into the project. Help your providers know that also. Our team works hard to not only point out deficiencies but also proficiencies of your providers and your organization, but at the end of the day, it is a mock carrier audit.

DoctorsManagement understands audits and reviews are an investment into your organization. We will work hard to ensure that your time, resources, and financial investment are used wisely and produce a good return on outcomes and deliverables.

How it works…

• Coding and documentation audits can be performed remotely or on-site at your medical office
• Your DoctorsManagement auditor will review a random selection of patient encounters to identify trends in your coding practices
• Audit findings with specific results are discussed and reviewed with each healthcare provider
• Throughout your review, you will receive guidance on best practices and how to address identified deficiencies and correct them
• Educational sessions with each key staff member, biller, and medical coding specialist will provide hands-on training and feedback to ensure they are equipped to assign the most accurate codes
• We will also include an evaluation of your practice’s fee schedule, modifier usage, utilization of CPT, ICD-10, and HCPCS coding, provider documentation, EOB denial trends, and productivity levels for Bell Curve analysis

What to do next…

1. Contact us to discuss your specific audit needs by calling (800) 635-4040 or email [email protected].
2. Read more: What can you expect from a coding and compliance review?

Why do thousands of medical providers trust DoctorsManagement to help improve their coding and documentation?

• The quality and experience of our coders and auditors — All of our auditors, based in the United States, receive ongoing training and support from our education division, NAMAS (National Alliance of Medical Auditing Specialists). Each team member has over 15 years of experience, are dually credentialed by the AAPC® (American Academy of Professional Coders) as Certified Professional Coders (CPC®) and Certified Professional Medical Auditors (CPMA®), and are proficient in the rules and regulations enforced by Medicare and commercial insurance companies.
• Synergy – DoctorsManagement is a full-service healthcare consultancy firm. The many departments within our firm work together to help clients rise above the complexities faced by today’s healthcare professionals. As a result, you receive quality solutions from a team of individuals who are current on every aspect of the business of medicine.

The full suite of DoctorsManagement solutions include:

Regulatory Compliance Consulting and Services

• Compliance Auditing-Pre-bill Audits, Retrospective Audits, OIG RAT-STATS, Billing Analysis, Staff Training, and Education
• OIG Compliance Plan Development
• Appeal of Overpayment Demands
• Medicare, Medicaid, and Private/Commercial Payers
• Physician Training -Specialty Specific Training, Provider Shadowing, and Education, Chart Audits
• Third-Party Compliance Officer for practices that do not have the capacity for hiring this position

Practice Operations Consulting and Support Services

• Practice Assessment
• Practice Management
• Practice Startup
• Revenue Cycle
• Coding & Documentation
• Credentialing & Provider Enrollment
• Managed Care Negotiation
• PowerBuying Program

How to Become a Medical Auditor

Certified Medical Auditors (CPMAs) utilize their knowledge of learning medical terminology, medical coding, and documentation guidelines to improve the revenue cycle of medical practices. A medical auditing career includes working with medical records technology and health services administration, applying your medical coding skills in a new realm. Associations such as NAMAS, AAPC or American Health Information Management Association (AHIMA) will give guidance on training for and certification exams, accreditation, and medical coding certificate if you would like to become a biller or coder.  A medical auditor career track can lead you to a rewarding position in offices charged with managing medical documentation, medical procedure documentation or medical services.  Types of courses include but are not limited to: certified coding associate, certified coding specialist, level ii coder, national certifications, CPT coding, procedure coding, certified professional coder certification (CPC), medical records review, icd-10 coding, CCS, or CCP designations, and the focus can be on inpatient or outpatient services.

Medical Coding Auditor Certificate & Exam Prep Course will help you pass the national board exam on the first try so you can become a professional medical auditor. Here’s what you’ll learn about in the course:

• Medical Records
• Coding Concepts
• Reimbursement Methods
• Quality Assurance
• Risk Analysis
• Scope Sampling
• Modifiers

Interested in a career as a medical auditor? Visit NAMAS in our education section. DoctorsManagement is here to assist.