By Adam Turteltaub

Chart auditing may not be the sexiest part of healthcare compliance, but it plays an important role in discouraging Medicare fraud and catching problems early.

Madhavi Perumpalath, Director-Physician Practice Compliance at Northeast Georgia Health System and Alka Kumar, Compliance Director and Privacy Officer at Resolve Pain Solutions, explain that CMS provides good guidance to healthcare providers, such as diagnosis and procedure codes that are appropriate to bill for. Take advantage of it.

Embrace proactive auditing, they advise, to help identify issues and ensure the quality of the claim before it goes out the door.  It can also prevent both over and under billing.

How frequently should you audit? It depends on several factors, including the size of your organization, regulatory requirements, resources available and the overall risk environment. And, remember, you can’t audit everything. Instead, they recommend developing an annual audit plan focusing on the high-risk areas, but also doing some random samples of other areas as well. This dual approach maximizes efficiency and minimizes overlooked issues.

Listen in to learn more about how to conduct the audits and what to look for.

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