More Auditing Is Needed In Today's Medical Practice!
By: Ashley Newsome, CPC, CPMA August 16, 2018
Medical chart audits have long been performed by government entities and payers for a variety of reasons on many levels. Why are provider offices and medical groups, large and small, not focusing more on internal auditing?
Those in the health care field have long known about the risk of audits and investigations. An audit does not necessarily mean an error or crime has been committed but is a check and balance of what was documented and provided to the patient versus what was billed to insurance company or entity.
Audits through the years have taken on a negative presence in the healthcare industry instead of boosting a positive culture of compliance within an organization. It is no secret that fines and penalties are overwhelming when they are levied or a settlement is reached.
Auditing is a valuable tool to ensure not only for coding and billing compliance, but also that administrative functions are performed properly and timely and that financial relationships are not improper or resulting in a Stark violation or anti-kickback.
Every office can’t employee a dedicated auditor and/or a compliance officer per se’. However it is not unreasonable to employ those trained in auditing and/or compliance to assist with auditing and monitoring standards within the organization to ensure compliance, minimize risk, and quickly identify and resolve any issues discovered.
Certification is an option, but not a requirement. The minimum expectation should be to have trained personnel within the organization to complete an internal audit however external auditors may be used to ensure efficiency, effectiveness and accuracy of the overall program internally. Education and training can be costly and maybe the training budget is nearly empty as we approach the second half of the year, but it won’t be more costly than recoupment and/or fines and penalties as the result of negative audit or investigation.