2023 Gastroenterology Reimbursement and Coding Update (Virtual)

Pdf Summary

This document provides an overview of best practices for auditing in the healthcare industry. It is presented by Kristin Vaughn, a healthcare consultant and lead auditor. The objectives of the presentation include understanding GI specific benchmarking, internal audit processes and compliance plans, types of payer audits, and how to respond to a payer audit.<br /><br />The document starts by discussing GI specific benchmarking. It emphasizes the importance of providers being aware of their utilization of Evaluation & Management (E&M) codes that are prone to audit review. Providers should compare their use of E&M codes to benchmarks for their specialty to identify deviations. If a provider is off the benchmark, they may receive letters from payers and random audits. The document provides a table of E&M codes with national percentages.<br /><br />Next, the document addresses internal audit processes and compliance tools. It advises assigning a staff member to review the billing process and develop a compliance plan. It recommends conducting regular internal coding audits and frequent coder training. The document suggests performing audits on a quarterly basis and determining the scope and type of review.<br /><br />The document then discusses different types of audits, including those conducted by the Office of Inspector General (OIG), Recovery Audit Contractors (RAC), and Certified Error Rate Testing (CERT) program. It provides details on specific issues pertinent to gastroenterology practices identified by the OIG.<br /><br />Finally, the document offers guidance on how to respond to a Medicare audit. It emphasizes the seriousness of audits and recommends consulting with an experienced health attorney. It advises providing all requested information, ensuring legibility of medical records, and including a summary of care provided. It stresses the importance of keeping copies of all correspondence and documents provided, as well as contesting audit findings if necessary.<br /><br />Overall, the document provides healthcare providers with useful information and best practices for auditing, benchmarking, and responding to payer audits.

Asset Subtitle

Kristin Vaughn, CPC, QMC, QMGC, CPMA, ICDCT-CM

Keywords

healthcare industry

auditing

best practices

GI specific benchmarking

internal audit processes

compliance plans

payer audits

E&M codes

billing process

Medicare audit