Don't Add Risk To An Already Risky Business - DoctorsManagement Don't Add Risk To An Already Risky Business - DoctorsManagement

Don’t Add Risk To An Already Risky Business

By Frank Cohen, Director of Analytics and Business Intelligence

As originally published by

In that past, I have opined on retroactive baseline probe audits (RBPAs) and why I think they are both ineffective and potentially dangerous, from a purely mathematical perspective. But one of the problems often spawned by RBPAs is the corporate (or practice) error rate, which in my opinion can prove as dangerous that the probe audit itself, if not more so.

First, a refresher: during a RBPA, a practice will select some fixed number of charts to review for a given physician over a given period of time. In my experience, the modal count seems to be 30, meaning that 30 charts representing 30 line items (services or procedures) are selected for a given doctor and then audited by an internal coder in an attempt to establish a potential pattern of improper coding. So for a 600-physician group, this amounts to some 18,000 charts per year.

From a coding perspective, since the purpose is to audit an already-coded event, which requires a bit more time and effort, we are talking in the neighborhood of 2.2 FTEs, assuming that this is all they do, day in and day out. So, what do you get for your money? Depending upon the specialty, a typical provider will report some 75 to 100 unique procedures and submit some 2,400 claims per year. If you pull 30 claims for a physician, let’s say at random, what do you think the chances are that those charts will all represent unique services or procedures?

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