Audit Risk

How comprehensively have you considered the possibility of a billing audit with detrimental results? Do you have adequate procedures and systems in place to prevent costly charges resulting from audit problems? If you think you don't need to be concerned with audit issues caused by such problems as compliance errors, think again. According to Improper Medicare FFS Payment Report (2003), "Chiropractors have the highest provider compliance error rate in Medicare, filing claims incorrectly 30.6% of the time".

Audit risk is something you should seriously think about and address now. Here are several tips for reducing audit risk:

1. Review your approach to documentation and make sure you fully document all patient interactions. This is critical because without sufficient backup, it will be difficult to fully justify claims. 2. When it comes to documentation, make sure you are using a billing and practice management system that makes it easy to add documentation to patient records regardless of the type of documentation or from where it originates. 3. Another useful systems approach to documentation is to install workstations at all examining tables to make adding documentation efficient and easy. 4. Make sure new patient records are correctly set up thus avoiding record keeping problems in the future. Make sure the first visit record contains such required information as a history of the patient's problem, findings from the examination, and initial diagnosis. An effective billing and practice management system should alert anyone setting up an initial patient record if all required information is not provided. 5. Enter original, high quality SOAP notes into your system on the same day a patient is examined to assure that accurate information has been provided. Also make sure SOAP notes records contain necessary information such as patient name and service date. If multiple people in your office enter SOAP notes, periodically review a sample of SOAP notes to ensure they are properly recorded. Again, a good practice management and billing system can make sure key required elements of each SOAP note are not overlooked. 6. Make sure that a treatment plan has been developed for each patient. An effective system allows for the setup of standardized treatment plans that can be easily assigned to a patient. 7. Meet with your staff and educate them about the importance of avoiding audits. Discuss what everyone can do to assure compliance. Reinforce the importance of avoiding audits on an ongoing basis.

If you are evaluating chiropractic practice management and billing software programs for implementation within your practice, ask the software vendors what specific system approaches and features the software provides to reduce audit risk. In addition, check client references the software vendor provides and ask those references for an opinion of the effectiveness of the software package they are using to reduce audit risk.

Your chance of a billing audit are high if you haven't implemented software to assure compliance and haven't stressed with your staff the importance of accurate and timely record keeping. Now is the time to address the audit risk issue so you can avoid problems in the future.