- How will our practice know if we are going to be selected for a Medicare RAC audit?
- What is the benefit of doing a Base Line Audit?
- Will our practice benefit from a third party audit even if we are already doing audits internally?
- Why would our practice want a third party to conduct this audit, why not just wait for Medicare to do their audit?
- From a logistical stand point how does your Base Line Audit service work?
- Do you provide any coding and documentation training?
- How often should our practice have a Base Line Audit performed?
- If a physician practice has a Base Line Audit performed, will they still be subject to an audit from Medicare?
- What if the results of the initial Base Line Audit indicate that there are serious documentation and coding issues with some of the providers in our practice?
How will our practice know if we are going to be selected for a Medicare RAC audit?
Unfortunately no one knows if they are going to be selected by the Medicare RACs to be audited. There are some physician specialties such as cardiology, rheumatology, radiology, and orthopedic that are considered prime targets for the Medicare RAC Audits as these practices typically bill significant amounts of Medicare and have high dollar value claims.
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What is the benefit of doing a Base Line Audit?
The Base Line Audit will determine if the providers within an organization are compliant with the Centers for Medicare and Medicaid Services at the time of the audit. The audit will identify those providers, if any, that pose substantial audit risk to their organization due to improper coding, documentation or rendering services that aren't deemed medically necessary. The results of the base line audit will assist us in identifying areas that need improvement at the individual provider level so that we can provide relevant training and education in order to bring your providers up to speed with proper coding and documentation in order to be compliant with CMS standards.
A Base Line Audit can also identify areas where your providers may be "down coding" and loosing out on legit billable charges. Once we identify such areas, we communicate this to you and our coding instructors educate you on how to code for maximum reimbursement and document appropriately to avoid any audit risk.
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Will our practice benefit from a third party audit even if we are already doing audits internally?
We highly recommend that organizations conduct internal audits if they have the qualified resources to do so. Unfortunately, most organizations do not have qualified staff with a compliance background that are capable of conducting internal audits. The main concern with conducting internal audits is that the person conducting the audit has to be independent of the charts they are auditing or their opinion will not be independent and could potentially be biased. If you are conducting audits internally, we recommend to at least have a third party come in every so often and conduct an audit so that you can compare your results to theirs to see if any major discrepancies exist.
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Why would our practice want to have a Base Line Audit performed, why not wait for Medicare to do their audit?
Medicare does not provide any compliance guidance to the physician or provider of care outside of giving them written guidelines. Most providers don't have the time to review these guidelines as they are focused on the daily obstacles of running their practice. The Recovery Audit Contractors (RACs) are paid on a contingency basis therefore they have every incentive to find incorrectly paid claims. Our Base Line Audit will help your organization identify any areas of deficiencies and allow us to assist you with correcting these areas prior to the start of any audit.
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From a logistical stand point, how does your Base Line Audit work?
The first step in the process is to have your practice provide us with a report for each provider that shows all their Medicare billings for a specified period of time. We then randomly select a sample of 50 patient encounters per provider that vary across different levels of office visits and other procedures billed for your specialty type. The corresponding patient charts for these encounters are then faxed through our secure HIPAA compliant fax line and stored in our web based HIPAA compliant web portal. This same technology has been approved and is currently being used by the US Department of Defense. Our auditors then audit each patient encounter and analyze the coding and supporting documentation to determine if any compliance issues exist. Once all charts have been reviewed we generate a comprehensive report of our findings. We will then contact you and set a time to go over the report with you and consult with you as to any corrections that need to be made to your documentation at the individual provider level.
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Do you provide any coding and documentation training?
We can schedule ninety minute one-on-one online trainings with each of your providers where a certified coding instructor will go over documentation compliance for physicians and get your providers up to speed in regards to how to properly document their patient encounters. We can also provide training for your billing staff that covers the essentials of coding for medical billing staff. Such trainings can be done in a group setting and tailored to meet your practice's needs. Our main objective is to provide you with the specific training you need based on the problem areas that were identified when the Base Line RAC Audit was performed. That way your organization can take corrective action and become compliant with CMS requirements.
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How often should our practice have a Base Line Audit performed?
We recommend that your practice have an audit performed at least annually. If the results of an initial audit identify areas of significant risk, we recommend that your practice continue with on-going monthly audits while your providers go through training to ensure that your providers receive the proper education and that corrective action is taken and future audit risk is reduced and potentially eliminated.
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If a physician practice has a Base Line Audit Performed, will they still be subject to an audit from Medicare?
Having a third party audit performed does not exclude you from the possibility of a Medicare audit. The claims that are audited by your third party can be excluded from any Medicare audit.
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What if the results of the initial Base Line Audit indicate there are serious documentation and coding issues with some of the providers in our practice?
We recommend that if you have a third party Base Line Audit performed, that all communication and correspondence go through your attorney so that any results and findings of a third party audit will be protected by attorney client privileges. The second step is to immediately take correction action and put a compliance plan in place and begin educating those providers that have been identified as a high risk about proper coding and documentation. In this case, on-going monthly audits are also recommended so that it can be assessed whether or not those providers coding and documentation issues are being corrected.
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