The Importance of Self-Audits

September 10, 2018

According to us “Experts”, annual self-audits are a good idea. Not only can self-audits clear up coding and billing issues before payers take notice, but these audits can also help you sort out any lost revenue issues your practice might be experiencing. Take this advice on the who and when of self-audits and see your practice vault past any potential compliance hurdles.

Perform Self-Audit At Least Annually

My colleague’s opinions vary on how often you should perform a self-audit; your self-audit frequency will depend on practice resources and other mitigating factors. No matter the practice’s individual situation, however, I would recommend that you perform audits once a year, at minimum, to ensure compliance.

Although you should perform audits at least yearly, you may want to do it more often. The number of self-audits could depend on anything from practice size to the introduction of new treatments. And it needn’t be permanent, you might want to conduct self-audits more regularly for a brief period, and then return to a six-month or one-year self-audit gap.

Examples: Let’s say your practice just started providing a new procedure or it is offering a new service. It’s important to audit the new service at the beginning, perhaps every 90 days for a period of time. Or if you hire a new physician, the practice should audit s/he after 30 days, and then again after 90 or 120.

If your practice has the infrastructure, it might conduct self-audits by claim. For example, if a practice performs an audit weekly, the findings and issues can then be brought to the managers and provider at weekly meetings.

Recommendation: Tailor your self-audits to your practice’s needs. Also, ask coding and billing managers to keep you posted about any changes to coding/billing practices or procedures. That way, you can introduce temporary self-audits on an as-needed basis.

Consider Coders First-Line Self-Audit Conductors

To flag down any potential compliance issues, everyone involved in coding and billing should be on alert for potential problems. Every employee should be tasked to look for red flags to indicate a potential problem. Problems should be brought to the attention of a designated manager. If you want to go this route, be sure to appoint a compliance manager who is charged with investigating reports of “red flags.”

When it comes down to who is performing the regular self-audits, options vary. The coder could perform the self-audit if s/he isn’t the one that codes the services. But use caution, because you don’t want to have someone audit their own work.

If you don’t have enough coders that you can successfully have all the work audited in-house, I recommend that you hire an outside auditor, or have someone in the office who is aware of coding perform the self-audit.

Be Pragmatic and Proactive

Self-Audits are well worth the effort. No matter which method you choose, your practice should have a self-audit schedule that includes deadlines for each audit and lists parties responsible for the audits.

Even though they might take some time, self-audits can only help the practice. Self-audit carefully, and you can launch a preemptive strike on coding and billing problems – before they become the stuff of nightmares.

Remember, it is easier to fix a drip before it becomes a raging torrent!

Previous post:

Next post: