Stay In Your Lane Stay In Your Lane

This auditing and compliance “Tip of the Week” was originally published by the National Alliance for Medical Auditing Specialists (NAMAS), a division of DoctorsManagement.

One of the elements of auditing that I find most satisfying is the provider education once the audit is complete, especially when the provider gets a high score and our session is upbeat and conversational. When the provider scores poorly, it can be challenging to create an upbeat and conversational session, and for obvious reasons: No one likes a failing score, especially when you have spent 12 years becoming a healthcare provider.

In these situations, I find it imperative to remember that while I am the subject matter expert in chart auditing, I am not the subject matter expert in the clinical conditions of patients. Having spent 10 years on the clinical side of the field as a surgical assistant to a group of general surgeons and dermatologists, I find that when I am reading charts for an audit, I may argue out loud (alone in my office) with the documentation and how it relates to the assessment and plan. Many times, I agree with the documentation, out loud, as well. Shortly after that I say (yes, out loud), “You are not a clinician, you did not stay at a Holiday Inn Express last night, and you most certainly are not the new lead actress on Grey’s Anatomy.” And I switch my clinical brain off and put my auditing hat back on.

I realized at the 11th Annual NAMAS Auditing & Compliance Conference last week that I am not the only one with these tendencies, and I found it a huge relief, but also a good topic for discussion. As an auditor, we need to ensure we are not taking this stance with our providers and that we stay in our lane. It can be easy to take an authoritative approach with our providers and say, “You can’t do this, but you should do that,” because after all we know best, right? Nope. So, let’s review a couple of suggestions when speaking with and helping to educate our clinicians.

  1. Don’t be argumentative, respect their knowledge. I prefer to ask the provider to walk me through their thought process after seeing the patient to understand why they are documenting a certain way. This opens the door for education to be provided without coming across as overly authoritative.
  2. Auditors, coders and providers use different languages, so we should bridge the gap by asking clarifying questions.
  3. Listen to the providers, pay close attention to pain points as well as areas of misunderstanding. Listening is the most useful tool in educating.
  4. Tell me a story. Walk the provider through simplifying the documentation (preparing for 2021 changes now codified in Medicare’s 2020 Physician Fee Schedule final rule) so that they tell you a story about the complexity of caring for the patient. It doesn’t need to be a novel. Encourage abandoning templates if possible.
  5. Remember to explain that the medical record doesn’t need to be dumbed down, but the patient does own their medical record, and therefore they should be able to understand what is in it.
  6. Ask. Ask. Ask. Do not infer what is there, ask the right questions.

Last point to ponder:

Should you prefer to be the clinician and don’t want to go to medical school, you may need to find a new medical drama other than Grey’s Anatomy because I think it is ending this season.

This Week’s Audit Tip Written By:

Heather Bollman, CPC, CPB, CPMA, CPC-I

 Heather is a Compliance Consultant for our parent organization, DoctorsManagement, LLC.

What to do next…

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