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

10_Auditing Best Practices_Vaughn

Pdf Summary

This document provides an overview of auditing best practices in the healthcare industry. The presenter, Kristin Vaughn, discusses the importance of GI specific benchmarking and understanding the utilization of Evaluation & Management (E&M) codes prone to audit review. Providers should be aware of benchmarks for their specialty and compare their claims for E/M services to identify deviations. Internal audit processes and compliance tools are recommended, including assigning staff to review billing processes, conducting regular internal coding audits, and determining the scope and frequency of audits. It is advised to respond promptly to payer audits and to communicate any policy changes to coding and billing staff.<br /><br />The document also covers different types of audits, including those conducted by the Office of Inspector General (OIG), Recovery Audit Contractors (RACs), and the Certified Error Rate Testing (CERT) program. Each of these audits focus on different areas of potential fraud, waste, and abuse in the Medicare program. The presenter emphasizes the seriousness of these audits and recommends consulting an experienced healthcare attorney to guide providers through the audit process.<br /><br />The response to an audit should be taken seriously, regardless of whether it is routine or involves suspicion of fraud. Providers should provide all requested information, ensure medical records are legible and complete, and include summaries and supporting documents to explain any unusual procedures or billings. It is important to keep copies of all correspondence and documents provided. Providers should also consult with a healthcare attorney early in the process and be prepared to contest audit findings if necessary.<br /><br />The document also mentions unannounced audits or raids, which are usually conducted by the OIG. In such cases, the practice administrator or manager should contact a healthcare attorney, and all employees, including physicians, should refrain from speaking with officials unless represented by practice counsel.

Keywords

auditing best practices

healthcare industry

GI specific benchmarking

Evaluation & Management codes

internal audit processes

payer audits

types of audits

potential fraud

healthcare attorney

unannounced audits