How an internal coding audit will help your practice prepare for a real one.
The second question in our “Ask Audrey" series, where Physicians Practice readers send in their practice management queries for guidance, deals with coding efficiently.
I have a practice of two cardiologists, a PA, and 30 employees. My administrator never came back after Hurricane Katrina. I have a clinical supervisor and a billing supervisor (here for three years with three other billers). We are very busy and I am not always sure if we are collecting optimally. I meet with them monthly to review the numbers. Should I have an audit, how can I satisfy my doubts about my efficiency?
Thanks for the question. The real answer likely lies within your doubts. If your gut is telling you that you are having efficiency issues, then an internal audit would be a surefire way to get to the cause of the matter. Generally, the cause of a question in billing efficiency begins when there is a cash-flow slow down. It sounds as if you haven’t experienced that yet, so hopefully you are being proactive in this matter
There are a few things you can do to check efficiency prior to moving forward with an audit:
1. Check your dates. Make sure there is no lag time between the date of service and the date the charge is entered also known as the date of posting. Office charges should have the same date of service and date of posting. Hospital charges should have five days or fewer between the date of service (or the date of discharge) and the date they are posted in your system (some of that responsibility lies on the physician to turn in those charges in a timely manner). Additionally, ensure that the claim filed date and the posted date are the same, for highest efficiency, you should file claims daily. If your office staff doesn’t file claims daily then there should never be more than five days between when the charge is posted to when the claim is transmitted.
2. Run reports routinely and review them. You should be looking at two main reports each month: the practice financial analysis and aging analysis reports. Your financial analysis will show you the charges generated, adjustments made, and amounts collected. This should be compared month-to-month and should be fairly consistent. If it is not consistent every month, this could be a sign of poor follow up, poor collection work, or even a sign of untimely billing. The second report you should review every month is the aging report: This report tells you what accounts have balances and how old the balances are. This can help shed light on collecting issues as well.
3. Track denials. Most EHR systems can flag this for you and create a report. Someone in your billing department should be tracking and following up on denials to ensure they are appealed in a timely manner. This should also be discussed in your monthly meetings to ensure maximum efficiency.
Ensuring these three items are reviewed at your monthly meetings with your billing staff should give you an idea as to whether an audit is required. Be sure and investigate variances in reports and follow up on collection notes for any balances over 90 days to ensure that proper collection attempts have been made.
Do you have a question about a practice management issue in your clinic? Would you like some ideas on how to fix a problem? Submit your anonymous questions to Ask Audrey and practice management expert Audrey “Christie” McLaughlin, RN, will answer them in a future Practice Notes blog.