Preparing for an audit is your best defense.
Everyone dreads a visit from the audit fairy, and it recent years the trend toward post-payment audits seem to be rising. An audit can upheave your practice, generate expenses, and keep you up at night. But before you imagine the worst, take a look at what an audit really means for your practice and review some simple and time-honored steps to ensure you make it through the process in one piece.
First, take a deep breath. Being audited doesn’t necessarily mean you’ve done anything wrong. In the rapidly changing healthcare industry, audits have become increasingly popular as healthcare management is becoming data management.
Although they can be painful, audits can often have a good side. Many practices have used them to take a hard look at their processes and have consequently made big, important changes in the way they practice. And those changes can help you sleep better every day thereafter knowing that your actions are well-founded.
Consider an expert
There’s no reason to go it alone, and there are many great reasons to bring in professional help. Just as you would call in a plumber or an electrician for a leak or a blown fuse, a professional advisor with experience in post-payment audits can be a vital asset in helping you navigate your way through danger.
If you think you can handle the audit on your own, by all means save the extra money. But if you feel unsure, consider employing the services of a healthcare attorney who is experienced with post-payment audits. They can also provide insight into how the auditors decided on your payment amount and subsequently help you formulate an appeal. Even if you choose to begin on your own, you can always bring in an attorney later.
Only a small number of audits expose true fraud, and most often they are a result of poor billing and coding practices. If you don’t have well- organized records, an audit is a good opportunity to review your processes and start making improvements. Set up a system that you can use moving forward and create documented compliance plans. At the very least, you will be better prepared to answer questions about your previous practices and better grasp the auditor’s ultimate assessments.
Even if you haven’t kept great records in the past, collect them as best as possible once you have been alerted you are under an audit. Organize office notes, chart notes, and documents; inform your employees that they may be questioned, and keep tabs on any paperwork you’ll ultimately need to produce. If you have an EHR system, this process should be fairly straight- forward. If you do not, now is a great time to consider moving your practice in that direction.
Get a little help from your friends
Do you know anyone who has gone through an audit? There is no shame in reaching out in your network for help and asking for other people’s experiences. Your peers will likely be able to help you weather the storm and provide valuable suggestions and strategies.
You may be tempted to cover up any mishaps or slip-ups in your record- keeping, or be combative and defensive. This will only slow down the process and cause more stress, along with reducing your opportunity for an incident-free audit. Your payer’s auditor is doing their job just as you are doing yours.
Be polite, respectful, and accommodating. But that doesn’t mean you have to offer up anything that hasn’t been requested. Lean toward providing only what asked for and nothing more. Be professional, timely, and engaged during your meetings with your auditor.
And just because you shouldn’t be disrespectful doesn’t mean you need be overly friendly. Remember: The auditor is there to do their business, not help you with yours. They want to make sure that your professional affairs are in order. Be prepared to let the truth speak for itself, regardless of the outcome, and move on with your life.
If you do get dinged severely, you may be able to negotiate your repayment. You can bargain for a reasonable amount on the grounds that large audits can’t possibly audit every date of service. Many times the final dollar amount is an estimate that can be bargained down.
If you think that a lot of extrapolation was employed to settle on a hefty number, it might be time to contact an audit attorney and see whether or not you can hold onto some of those post- audit dollars. In short, sometimes it pays to audit the auditor. But if this is your predicament, definitely have a specialized lawyer help you.
Position yourself for success
With the ever-growing documentation and compliance complexities that come with government regulations and mandates, incorporating an EHR software system in your practice has moved from a nice-to-have option to an absolute necessity. The right software can go a long way toward helping you achieve and maintain compliance.
Look for software that incorporates macros and automated reminders in the documentation process that guide you toward compliance.
Suffering through a post-payment audit is no fun for any provider. But if you do your research, consider the services of a professional, stay on the level, and organize yourself, you can breeze through and come out on the other side with a better handle on your business and with the assurance that next time—if there is a next time— your audit will be merely a cursory exercise.
Steven J, Kraus, DC, FLACN, DIBCN, FASA, FICC, is the chief market strategy officer for ChiroTouch, a provider of chiropractic EHR and practice management software. he is an acknowledged expert in health IT, electronic health records, and HIPAA issues. Kraus serves on national committees involving EHR and clinical quality guidelines. he can be contacted through chirotouch.com.