Conduct Mini-Audits to Be Sure You Are Capturing Charges
By Judy Capko
Conducting mini-audits is a powerful tool. It will help you determine if you are making costly coding errors or missing charges. For example if you missed charging for one EKG, one urinalysis a day and one hospital or office visit a week, it would add up to as much as $20,000 a year in lost revenue.
Begin by choosing a staff member from the business office and clinical department to develop a standard audit tool and conduct the audit. Select ten random patient records and use the audit tool to document inconsistencies.
The patient record is the base for your defense, so each document reviewed should match the patient chart. Compare the services documented on the appointment record, the chart the charge slip and the computerized patient ledger.
You can extend this audit even further by examining the insurance claims form (HCFA 1500) and the explanation of benefits provided by the third party payer. This will give you the opportunity to identify claims payment errors resulting in potential loss revenue.
Where discrepancies occur, take action! You may need to revise the daily audit process to ensure charges are posted for each patient on the daily office and hospital schedule. Or, perhaps a coding in-service is needed to ensure E&M codes are selected appropriately.
Regardless of the types of errors you discover, it would be wise to continue conducting internal mini-audits on a regular basis. It is an excellent way to be sure you are capturing all your charges and getting paid for what you do!
Figure 1
Common discoveries with a mini-audit
Discrepancy in evaluation and management level of service (E&M code)
Inappropriate use of modifiers
Wrong diagnosis
Missing dictation
Physicians not participating in the coding process
Incomplete charge slip
Missed office charges: Procedures, lab, x-ray
Missed hospital charges: ER visits, consultations
Error in third party payment
Insurance write offs taken that are not justified
Patient balances written off on Medicare patients
Judy Capko is a healthcare consultant with more than 20 years experience. Her focus is practice operations, staffing, finance and marketing. Judy is a national lecturer and has participated in ACOFP conferences. She is based in Thousand Oaks, CA and can be reached at (805) 499-9203 or e mail: judycapko@aol.com
