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Be Prepared for an Audit

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When ophthalmologists are audited and they want best case/worse case scenario, they tend to call me. It is interesting to note that when a physician calls, he/she begins with, "Guess what my staff has done wrong." And when a staff person calls, they tend to begin with, "Guess what the doctor has been doing incorrectly." While it is true that the physician is ultimately responsible for documentation and subsequent code and diagnosis code selection, staff must be of immediate and ongoing assistance.

Medicare, as well as all third-party payers, conducts audits. And they will continue to do so, in part, because they recoup so darn much money from providers. So it is in our best interest to proactively prepare to be audited.

Simple Tips
  1. Routinely conduct internal chart audits on your E&M and eye code examinations. Every quarter, look at each physician’s procedure productivity report and note which exam codes are billed most frequently. Pull three or four charts and begin auditing to assure that the level of documentation is met. If it is not, immediately take corrective action. If it is, celebrate and congratulate everyone involved.
  2. Print and read your Medicare payer’s Local Coverage Determinations (LCDs). These are the documentation rules and regulations that you will be held accountable for during an audit. For more information, a list of Medicare payer Web sites can be found under Coding Tools section of the AAOE coding and reimbursement home page
  3. Keep up-to-date on payer changes by signing up for list-serves. These are quick updates that save you from having to search the Web sites regularly.

Related Resources
Looking for other ways to prepare for an audit? Check out these related articles from the YO Info archive:

You can also get access to list-serves like those mentioned above as a benefit of membership in AAOE, or get updated on all state-specific coding changes by attending a CodeQuest seminar.

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About the author: Sue Vicchrilli, COT, OCS, is the coding executive for the American Academy of Ophthalmic Executives.