Treating Medicare patients is accompanied by the necessity to internalize the system's insurance policies and countless rules. Naturally, this can be pretty overwhelming at times. The constant looming threat of an audit doesn't help ease any worries either. What if you could avoid a Medicare audit altogether? Here are some tips that might help achieve just this.
When it comes to Ambulatory Surgery Center (ASC) services, accurate and detailed billing documentation is a must to avoid Medicare audits. It is important to have a thorough understanding of what constitutes "reasonable and necessary" as per the definition given by Medicare for charged services. This helps avoid unbundling (e.g., charging separately for consultation, dressings, and hot packs) or up-coding (i.e., billing for a service more expensive than the one that has actually been provided) errors, which in turn prevents you from submitting a false claim that could bring on an audit.
Where do you stand on E & M coding?
Statistics show that physicians who have a tendency to over-code, in comparison to their peers, when it comes to evaluation and management (E&M) services, face a much higher risk of an audit. Reviewing coding patterns on a regular basis can help avoid this error. The knowledge of exactly where you differ in your coding patterns can help you take appropriate steps to correct the issue, either through additional education or with the help of a certified coder.
While templates are acceptable, documentations need to be detailed, precise, and patient specific. Time of surgery, execution of advanced beneficiary notice (ABN) for non-coverage services have to be mentioned. It is worth noting that illegible signatures, reproducing signatures with a stamp, along with failure to supply records when requested increase the likelihood of a Medicare audit.
Using modifiers efficiently
Ever since the Physician Payment Reform was implemented in 1992, modifiers have become crucial to the Medicare billing process. Using modifiers correctly can help ensure payment for services that would very likely be denied, if not for the appropriate modifier mentioned. Additionally, reporting multiple services without the correct modifier can raise suspicion that the caregiver is engaged in "unbundling". When used appropriately, modifiers are integral to both avoiding a Medicare audit and increasing in-house revenue.
Calling in the expertise of a certified coder to audit your performance can help uncover potential problems. Even if it is on annual basis, this can help pinpoint areas in which you will benefit from the further training. Most importantly, regular coding audits effectively demonstrate the efforts you are taking to code correctly. This greatly helps your case if, heaven forbid; you are faced with suspicions that question your honesty. Regular audits are proof that any billing and coding errors are not intentional.
A Medicare audit can be an intimidating prospect for any healthcare center. And while it would be ideal to avoid it altogether, it isn't always possible. For this reason it is important that surgery centers keep up with the guidelines and coding rules implemented by Medicare, along with monitoring previous audit results to eliminate issues brought up in the past for good. It may be impossible to avoid a Medicare audit, but following these tips will, at least, ensure that you are well prepared.