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Don’t Land in Hot Water-Audit Proof your Coding and Documentation

Nikki Taylor MBA, CPC®, COC™, CPMA® July 28, 2016

Thu, Jul 28, 2016
11 AM EDT
1 AAPC - Approved CEU for CPMA, CPC, CPCO

 

With so many changes taking place in the healthcare industry, it’s inevitable that at some point you will be prompted for a payer audit. In fact, many practices have seen an increase of requests for medical records from commercial and government payers for payer audits. Prepare yourself! Some of these reviews can include several patients and last for a long time.

 

Would you pass an audit if you received one of these requests? Join speaker Nikki Taylor MBA, CPC®, COC™, CPMA® during our webinar today to learn about areas of concern that could be eliminated with regular self and external audits.

 

During this power-packed session you’ll know:

  • Top focus areas for government audits and how the auditors work.
  • Why audits are important. Completing regular audits is just good practice. You can mention audits as “reviews” to ensure your employees don’t hear the word “audit” and panic. Some employees may equate “audit” with finding mistakes and consequences, but “reviews” are considered more like checkups of your coding and documentation practices.
  • There are two types of audits — internal and external.
  • Internal audits are done in-house, and they involve staff already employed by a physician practice or healthcare organization. For larger organizations, there are usually designated auditors or compliance officers who conduct the audit. For smaller practices with just a coding department, coders or a coding manager would conduct the audit. If you belong to a very small practice, and there is only one coder available, an external audit may be the best solution for you.
  • Two basic methods for completing audits: 1. A prospective audit helps you identify and correct problems before sending the claim to the payer. Prospective audits will likely delay your billing process, but it’s the best method for auditing internally because you can correct any issue you find before sending it out to the payer. 2. A retrospective audit is a post-payment audit. This audit does not delay billing, and the entire process can be completed rather quickly.
  • When it comes to choosing how to complete an audit, there’s no real right or wrong method. You just have to determine which way works best for your environment and take your cash flow into consideration, as well.
  • Basic concepts you must understand to conduct a successful internal audit:
    • The audit’s scope — what you’re looking for.
    • Select a random sample of charts to audit, and ask a coworker to pull a patient list.
    • Don’t audit your own charts.
    • Remember that coding and documentation auditing are equally important.
    • When providing reports at the completion of the audit, make sure they are professional and educational.
  • With an external audit, an experienced external auditor will help you determine what you need to review. Your scope can be broad-based or more focused. The external auditor can also help you decide whether to conduct a prospective or retrospective review. Selecting an outside auditor ensures a special skill set for auditing. The expectation is that they are extremely knowledgeable and more likely to have the necessary resources on hand. They can also objectively examine the data with a fresh eye to discover any weaknesses that could lead to allegations of wrongdoing or to a loss of appropriate revenue.
  • By conducting regular audits, you can:
    • Identify areas for improvement in documentation.
    • Point out billing corrections that need to be made.
    • Check ICD-10 coding to ensure specificity and precision.
    • Crack down on insufficient provider documentation.
    • Avoid undercoding, overcoding, and bad coding habits.

Take charge of your coding and documentation compliance and be sure to sign up today! Earn 1 CEU for joining this session presented by The Coding Institute (TCI).

 

Who should attend:

  • Practice Managers
  • Office Managers
  • Physicians (MD)
  • Certified Professional Compliance Officers (CPCO™)
  • Certified Medical Coders (CPC®)
  • Certified Professional Medical Auditor (CPMA®)
  • Billing/Reimbursement Specialists

 

Note: The AAPC CEU is available to all live webinar attendees. CEUs for archived webinars are available only to SuperCoder subscribers.

 

Speaker Bio:

 

Nikki Taylor

MBA, CPC, COC, CPMA

 

Nikki Taylor, MBA, CPC, COC, CPMA is an auditor for The Coding Institute (TCI) where she completes audits for several customers including, large and small group practices, specialty clinics, and hospitals. She has more than a decade of experience in coding (multispecialty) and auditing, billing and practice management. She left the physician practice world for her current role with TCI. Nikki holds a Bachelor of Science in Healthcare Management from Mount Olive University in Mount Olive, North Carolina and a Master’s Degree in Business Administration with a concentration in Healthcare Management from Saint Leo University in Saint Leo, Florida. She obtained her (CPC®) Certified Professional Coder certification, (COC®) Certified Outpatient Coder certification, (CPMA®) Certified Professional Medical Auditor certification through AAPC. She maintains her coding knowledge through education, attending conferences, seminars, and reading coding periodicals and newsletters.

 

CPC®, COC™, CPCO™ and CPMA® are registered trademarks and copyrights of AAPC.

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