Compliance auditing tips for physician practices

Ever wonder which physicians should be audited to make sure your physician practice is and stays in compliance with the myriad of billing and coding rules out there today? Here are a few examples of identifying and auditing physicians with the following patterns (this includes solo-practicing physicians):

• Routinely billing high level E/M codes
• Billing high level codes for follow up visits
• Always using the same E/M code
• High overall work relative value units (RVUs)
• Physicians with a high number of services per day
• Billing for procedures that others of the same specialty are not billing
• High volume of certain modifiers billed, such as modifiers -25 and -59
• High denial rates
• Attempts to unbundle or bill services that may not be medically necessary

About the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.