Over the years, we’ve been asked to help physician practices with the always-in-demand chart audits to provide peace of mind that the documentation supports the code billed.
Due to the importance of Evaluation & Management (E&M) procedure codes to most practices, we have become experts on E&M chart audits, in particular (although we can audit any procedure or diagnostic code).
With the beginning of the Medicare Recovery Auditor Contractor (RAC) program in 2012, Physicians’ Ally, Inc. has many clients who have been proactive initiating chart audits to be sure that any government or commercial payor conducting a review of their documentation would find things in order.
Since we teach Coding Education, we hire our best students. We have 11 certified professional coders (CPCs) on our Physicians’ Ally, Inc. team today. To do a chart audit correctly takes a great deal of time and expertise. This challenge is attractive to the CPCs on our Physicians’ Ally, Inc. team, who are eager to audit charts as part of our larger mission of helping practicing physicians’ in all aspects of running (and improving) the business component of their practices.
Please contact us to discuss your practice’s chart audit needs. We’d be happy to discuss how to pull a sample of charts, and our data request with you. It’s easy to get started.
How we do Chart Audit engagements
Due to the subjectivity inherent in chart audits, we assign a team of auditors to each Chart Audit, and compare the findings internally. The client receives the culmination of our best efforts.
We charge an initial fee to begin the engagement, and a fee for up to 20 charts. Additional charts are billed at an hourly rate. The scalability of this pricing allows the chart audit sample size to fit into any budget. Lastly, our closing fee covers our write-up of findings and presentation at the practice/board level. One-on-one provider conferences are available for discussing individual chart findings, and these are billed at the hourly fee.
In many chart audits, we find that physicians are under-coding for their services to be conservative, resulting in lost revenue to the practice. In one engagement, the practice would have made an additional $6.84 per visit, had they coded for what their documentation allowed. Imagine the impact on the practice if the results were extrapolated beyond the charts sampled for the audit!
Targeted Audits Pay Dividends for Payers
CMS has set ambitious targets for reducing improper payments. In 2013, the target was 8.3%. It fell to 8% in 2014, and 7.5% in 2015. To achieve these rates, CMS is likely to ratchet up enforcement efforts - including payer audits - in the months ahead. CMS and OIG have said that audits recover $8 in improper payments for every $1 spent in recovery; a recent report released by Taxpayers Against Fraud Education Fund (www.taf.org) concludes that every dollar invested by the government in investigation and prosecution of federal healthcare fraud returns at least $20 back to the American people. - AAPC’s Healthcare Business Monthly - April 2014