Regular medical record audits are essential for practices aiming to maintain compliance and maximize revenue. At Practice Compliance Solutions, we offer these audits to identify documentation discrepancies, ensure adherence to payer requirements, and uncover potential revenue opportunities to keep your practice running smoothly.
Key Benefits of Medical Record Audits
- Identify Documentation and Billing Issues: Comprehensive Audits help detect inconsistencies in documentation and billing, allowing for you to take corrective actions before the official auditor comes around. Staying proactive minimizes the risk of penalties and refunds.
- Ensure Compliance with Payer Requirements: Compliance isn’t optional; regular audits demonstrate a commitment to meeting the expectations of payers and regulatory bodies and is crucial for maintaining good standing and avoiding potential sanctions.
- Uncover Revenue Opportunities: Audits can reveal areas where medically necessary services are underutilized, improperly coded, or undercoded, enabling you to offer comprehensive care and optimize revenue streams without worrying about leaving money on the table.
Implementing Effective Medical Record Audits
Incorporating medical record audits into your compliance program is a strategic move while there are no national mandates for voluntary audits, the Centers for Medicare & Medicaid Services (CMS) recommend reviewing a minimum of ten patient encounters per provider annually. Some insurance payers may also require evidence of such audits for credentialing purposes.
Audits can be conducted internally or through professional services. Choosing a professional audit can provide valuable insights and establish a robust compliance framework. Subsequent internal audits can be performed annually, with professional audits recommended every three to five years to ensure ongoing compliance and effectiveness.
Consequences of Non-Compliance
It’s no secret that non-compliance with billing, coding, and documentation regulations can lead to significant penalties, including fines and potential exclusion from payer networks. Regulatory bodies enforce these laws rigorously, and ignorance is not a defense. Consistent audits help your practice stay informed about regulatory changes and maintain compliance to avoid these costly repercussions.
Choosing the Right Audit Service
There are plenty of options out there for practices looking for medical records audits, but only Practice Compliance Solutions offers optometry-specific audit services to meet the unique needs of your practice:
- Comprehensive Chart Audit: This service provides an in-depth analysis of medical records, billing, and coding practices. We recommend reviewing 20 charts per provider, with customizable packages available for larger practices. The audit includes a detailed report highlighting documentation issues, coding errors, and potential revenue losses due to underutilized services. The cost is $1,500 per 20 patient encounters.
- Basic Audit: Meeting CMS’s minimum audit recommendations, this audit compares billed services against medical record documentation to verify payment eligibility. Priced at $750 per 10 patient encounters, it offers a cost-effective solution for maintaining compliance.
By choosing Practice Compliance Solutions for your auditing needs, you can ensure compliance, optimize revenue, and focus on delivering exceptional patient care. Our expertise in medical record audits provides peace of mind and a solid foundation for your practice’s success.
For more information or to schedule an audit, contact Practice Compliance Solutions today.
