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Cardiology practices cope with the challenges emerging from changes in medical record auditing

June 03, 2013



Medical record auditing is undergoing changes and this has made even the most prepared physicians nervous. Quality of care and services offered by a medical practice is determined by the thoroughness of clinical documentation and medical records maintained by the practice. Therefore, for every Cardiologist, already facing the recent revision to cardiology fee schedule besides other regulations and stricter reimbursement environment, aligning reporting procedures to audit expectations has become crucial to avoid audit costs and penalties.

However, with changes in medical record auditing, physicians find themselves in a grey area where it is hard to determine what to expect at the time of an audit. To ensure error free reporting and align with international accounting standards, medical record auditing standards SSAE 16 are replacing SAS 70 standards. Some key SSAE 16 changes address the issues of record focus, basis, period, assertion, management and usage; effectively covering the loopholes or drawbacks in the SAS 70 audit standards-

  • The basis of reporting has shifted from management’s discretion to risk basis for controls implemented
  • Documentation and system description is expected to cover entire period of testing
  • Assertion is no longer audit based but attestation based, with management’s written assertion being important
  • SSAE 16 standards are meant to make records usable by management and auditors, not general public

Although adherence to all new changes can prove to be challenging, aligning current systems to these audit standards can save your Cardiology practice a lot of money and hassle in the long term. Effective Revenue Cycle Management is the most productive way to adopt compliance regulations and prepare your practice for Cardiology auditing. Implementation of SSAE 16 standards will not only help you cope with emerging audit challenges but also improve quality of system and reporting at your practice. Adopting following changes can prove fruitful at the time of audit –

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  • Conduct internal audits and or subscribe to services similar to audit which can expose gaps in your system
  • Identify reimbursement deficiencies and claim frauds or inaccuracies
  • Identify problem areas in your billing and coding activities before the same can be challenged by government or insurance providers. Identify over coding or incorrect coding as well as bundling habits to bill as per documented procedures
  • Monitor variation of your practice from national averages due to insufficient documentation, erroneous coding or revenue loss
  • Verify EHR and ICD 10 usage for audit readiness

Preparing your Cardiology practice for all the various changes along with the challenges brought on by changes in medical record auditing is nothing short of a herculean task. Patients and insurers expect quality healthcare at consistently reduced costs but fail to understand the administrative and financial burden that causes for a medical practice.

Medicalbillersandcoders.com is undoubtedly the best partner that you can choose for your practice to deliver on all fronts. With medical and legal experts well versed with regulation and standard changes, we provide unmatched services to bring your Cardiology practice up to date with industry norms. You can let us handle every nuance pertaining to audit of records and focus on delivering improved healthcare to your patients.

 

Category : ACA / HIPAA / Reforms