I just finished a FREE 4 part series with Kathleen Schaum about keeping money after an audit.
Here are the top 10 things that Kathleen Schaum listed as the reasons doctors and hospitals lose money when audited (my paraphrase of what she said):
- Lack of documentation to establish medical necessity for the services (the “why” of a procedure or service)
- Not updating the ICD10, CPT and HCPCS codes annually –
- Not establishing a process to monitor announcements from payers
- Not establishing a process to monitor Medicare NCDs (national coverage determinations) and your Medicare Administrative Carrier’s (MAC’s) LCDs (Local coverage determinations)
- Not paying attention to your contracts with private payers
- Not reviewing the pertinent chapters of the NCCI manual for the procedural edits
- Not reporting the correct place of service on a claim
- Failing to negotiate contracts with skilled nursing facilities
- Not documenting referrals and obtaining those medical records
- Not documenting thoroughly and succinctly
There is a wealth of information in this series that could help you survive an audit… and everyone is being audited!
Here are the links to all of the sessions:
Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/c/carolinefifemd/videos