2022 Gastroenterology Reimbursement and Coding Update: Concrete Solutions to Strengthen Your Foundation in GI Coding and Billing | November 2021-10_Auditing Best Practices

10_Auditing Best Practices_Vaughn

Pdf Summary

In this presentation on auditing best practices in healthcare, the speaker discusses various topics related to audits, compliance, and responding to audits. Some key points include:<br /><br />- Providers should be aware of and understand their utilization of Evaluation & Management codes prone to audit review.<br />- Benchmarking and comparing a physician's claims for E/M services to specialty benchmarks can help identify deviations and minimize the risk of an audit.<br />- Internal audit processes and compliance plans should be developed and reviewed regularly.<br />- Conducting internal coding audits and regular training can help identify and correct any billing errors.<br />- Communication is key, both within the coding and billing staff and with payers, to ensure consistency and accuracy in coding and billing.<br />- Different types of audits, such as those conducted by the Office of Inspector General (OIG), Zone Program Integrity Contractors (ZPICs), and Certified Error Rate Testing (CERT), are discussed.<br />- When responding to an audit, it is important to take it seriously and provide all requested information in a thorough and organized manner.<br />- Consulting with an experienced health law attorney early in the audit process can be beneficial and it may be necessary to contest the audit findings.<br /><br />The presentation also touches on specific issues pertinent to gastroenterology billing and audits, such as the use of specific E/M codes and modifiers, and the importance of proper documentation and record corrections.<br /><br />Additionally, the speaker discusses unannounced audits and raids, emphasizing the need for the practice administrator/manager to take charge and contact healthcare attorneys while ensuring that employees, including physicians and providers, do not speak to officials without legal representation.<br /><br />Overall, the presentation provides valuable insights into auditing best practices in healthcare and offers guidance on how to successfully navigate the audit process.

Keywords

auditing best practices

healthcare audits

compliance

audit response

Evaluation & Management codes

benchmarking

internal audit processes

coding audits

communication in coding and billing

types of audits