Regardless of the type of audit a practice is performing, the starting point for most of them is internal.
Reed Tinsley, a certified public accountant, was working with a gastroenterologist a few years ago who was coding a large number of established office visits at 99214. When Tinsley compared the physician with the national average among his peers, he was an outlier. When Tinsley had about 50 of his charts audited, he found the provider’s documentation supported the high coding.
Shortly after the audit, the physician received a letter from Humana saying he was coding exorbitantly high and he needed to lower his codes. The physician responded with the results of Tinsley’s audit and was able to continue coding as he had been.
For most providers, auditing seems like a burdensome, costly, and time-consuming task, serving only to prevent problems that may never arise.
“In this country, most medical practices that dominate the landscape are between 1 and 10 physicians,” said Tinsley, a past president of the National Society of Certified Healthcare Business Consultants. “And with groups of…
