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Be Proactive by Performing Chart Audits

Wednesday, March 18, 2020 9:00 AM

Billing, Coding & Compliance

Written by: Elizabeth Cifers, Kirk Mack

From left, former Senior Consultant Elizabeth Cifers and Senior Consultant Kirk Mack

With the first quarter of the new year nearly over, many practices have embarked on another year of compliance efforts, including scheduling their annual chart audits.

Chart audits are designed to educate providers on whether their documentation for a service supports the submitted — and usually paid — Current Procedural Terminology (CPT®) codes, ICD-10 codes, and modifiers. The information collected from chart audits not only helps instruct providers but also staff on “best practices,” ensuring that all personnel understands the documentation requirements for the most common CPT codes used in the practice.

Knowing that, the value of performing an internal annual chart review cannot be overstated. It is also important to have periodic external chart audits to ensure that the most current regulations and rules are understood, being applied, and followed by everyone in the practice. That is especially true given the amount of outside scrutiny by the government and other third-party payers.

Some external reviewers in the ophthalmology space include:

  • The Centers for Medicare & Medicaid Services (CMS) through its Targeted Probe and Educate (TPE) program,
  • The Office of Inspector General (OIG) with its Work Plan,
  • Recovery Audit Contractor (RAC) auditors, and
  • Comprehensive Error Rate Testing (CERT) auditors.

Knowing in advance that the documentation in a patient’s chart supports the codes billed gives peace of mind to everyone concerned. Knowing versus believing, thinking, or hoping is a very different confidence level. To become knowing, chart audits need to be done.

Designing Your Chart Audit

Performing audits, however, raises many questions. How often should they be done? What should be audited? How many providers should be audited? How many charts should be audited? Where will the time to do an audit be found amid daily tasks?

The good news is that chart audits come in all shapes and sizes, and they are customizable to each practice’s needs. There are several factors to consider when designing a chart audit.  

  • Whether to perform the audit retrospectively or prospectively.
  • What CPT® codes to focus on.
  • Whether to audit a six-month or 12-month period.
  • How many charts per provider to review.
  • How many providers to review.
  • Whether to include corresponding ambulatory surgery center (ASC) charts.

Deciding all this can be overwhelming for many practices. Luckily, we at BSM can conduct a customized chart audit based on your needs and practice goals.

New Offering

As part of our consulting services, we are now offering Utilization Analysis (UA) to our clients as an add-on to their chart audit to identify areas of potential opportunity and risk. The UA compares the practice distribution of office visits and the frequency of diagnostic testing and select surgical procedures to CMS averages for ophthalmology and optometry.

Outlying data is not in and of itself “bad” but rather a directional indicator that risk may be present and, in some cases, an opportunity may exist for practices. Many providers believe utilization greater than the related CMS benchmark is the only risk to them. However, utilization that falls below the CMS benchmark may identify services that were provided but were not captured in the revenue cycle.

By performing a UA, we reveal areas where the practice or individual providers may have opportunities and, at the same time, identify areas of potential risk if audited by a third-party. Sometimes it’s easier to have an external entity rather than a practice employee call out and educate providers and staff on the “whys” of their documentation to promote compliance.

A Valuable Tool

Performing chart audits in the new year should not be overlooked. They are a valuable tool for practices. The results reinforce the accurate documentation practices being done, provide a learning opportunity for staff and providers, and identify areas for improvement. Minimize your risk by playing offense rather than being forced to play defense.

SCHEDULE YOUR REMOTE CHART AUDIT. While chart audits are an important part of staying compliant, we understand that the current climate and need for social distancing requires certain precautions. With that said, we are available to perform off-site chart audits. Learn more by visiting our billing, coding, and compliance page or contact us.

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