Government regulators do spend more of their time auditing larger practices, according to Fossum, but that doesn't exclude them from pursuing small practices at the same time. "Nobody is out of the woods or sequestered from the [auditing] process. The government has put significant resources into looking into everybody."
There are certain actions, all of a sudden changing the way your practice consistently codes that will always trigger an audit, no matter the size of the practice, according to Cloud-Moulds. For example, "If you all of a sudden stop coding 'office visit, office visit, office visit,' you could trigger an audit," she says.
When it comes to being audited, it's all about a practice’s documentation. "If Medicare can come see your chart notes, and they see detailed documentation, they will move on. Without good documentation, Medicare is going to see a problem and want to look at more charts. Size doesn't matter," says Cloud-Moulds.
Avoiding the Common Mistakes
Bewley suggests practices engage in their own in-house auditing and catch errors before they gain steam. "Audit both the services you're providing and how you are billing for those services. You want to have some semblance of a compliance program. Unless you're checking on your own practice, you won't know [of errors] until someone else tells you," says Bewley.
Often, especially in small practices, physicians paying more attention to the billing and coding process would go a long way towards cutting down billing errors, according to Fossum.
"Most physicians think their piece of the practice management pie is the patient care. Altruistically, that is where their intentions should lie…you can't stick your head in the sand as a practice owner or a physician who needs to pay attention to those business pieces of the practice," says Fossum.
Cloud-Moulds says education is the only way for practices to stay on top of billing and coding regulations, suggesting webinars from Medicare as a good place to start. She also says having billing and coding in-house is an advantage.
"If you don't have a conscientious billing department they will just let a denied code sit as an error and not teach you. If you have an in-house billing department that is involved with the education with the practitioners, that's where your advantage is," says Cloud-Moulds.
Furthermore, practices should always pay attention to the mail they receive from payers, even if it appears to be a simple postcard. "That little postcard is the payer's requirement to let practices know of a change they made in the provider network or the provider directory. Something could have changed that could affect the way you are coding and/or billing," says Cloud-Moulds.