Your Benefits with a Nteon Practice Consultants' Audit
This process begins with a through review and evaluation of your Medical Records. This is a critical process as failure to pass an audit would result in significant cost to the practice which includes the return of reimbursements Plus Penalties Plus Interest.
However, your audit with Nteon Practice Consultants includes far more.
Review of examination documentation
This is a comprehensive review of your examination documentation. We follow the NCCI compliance requirements which is used during an audit from Medicare or other payers.
It is important to point out that most EHR systems are not compliant, many have a process to verify your exams are compliant. However, this most of these are completely inaccurate and automatically count elements as completed even though they are not in your examination.
Thorough review of all aspects of the exam (Note: Failing any one of these requirements will result in failing an insurance audit!):
o Patient, Family Social History
o Review of Systems
o Typically we find incomplete history, inconsistencies between Medical History, Medications and ROS.
Most denials in an insurance audit are a result incomplete or inconsistent history.
o Another problem is pulling forward information from previous exams. This is frequently used at practices.
If not updated in the current exam it is considered Cloning and will result in an automatic denial of the exams.
o During our audit we spend time with the techs who record history. It is important for your staff to understand why their input into the record can cause you to fail an audit.
o Slit Lamp
Depending of the type of exam there are up to 14 examination elements. Most examinations we see do not have the required elements.
o Each procedure requires an Order in the exam. This must document what procedure is being performed, why the procedure is necessary and when the procedure is being performed. There also must be a separate order for each procedure.
o Procedures also require a compliant Interpretation & Report. Most reports do not have the required categories. During a report audit, payers find over a 80% failure rate.
Increase Your Future Reimbursement -
o We review what coding changes or better documentation would have supported increased reimbursement through higher levels of exams and additional procedures.
Complete documentation of:
Documentation in the exam of all Diagnoses and Procedures
It is important to point out that when we talk with doctors who have had an insurance audit they fully believed their documentation is complete and compliant. They also stated they expected their EHR system verified compliance. Of all the EHR systems we have reviewed, most incorrectly verify compliance. Result: In an insurance audit on average the practices fail over 90% of their exams.
Verification of Compliant Interpretation & Report - More than 80% of Eye Care doctors do not create a compliant report. There are three required components. Most EHR systems that claim to have a report does not record all the required components. We make sure your reports are compliant.
HIPAA Review – During this study we will evaluate multiple components of HIPAA compliance. We will identify all HIPAA problems and instruct you and your staff how to correct them and avoid HIPAA penalties. CMS is getting more aggressive in HIPAA audits. Including surprise visits through their scheduling of a "new" patient.
Billing and Reimbursement -
· We start with ensuring all diagnoses and procedures are documented in the exam.
· Through our extensive experience in coding and examination documentation requirements we identify all areas where:
Documentation does not support the exam levels billed. We make recommendations for correcting these insufficiencies in future exam documentation.
· Next is our comparison of the diagnoses and procedures on the claim.
These must match exactly of during an audit all of your charges will be denied.
If not, it will result in returning all reimbursement, plus interest plus penalties.
· Comparing your fees to the reimbursable fees for your region.
Most practices' fees are lower than the reimbursable which results in lost reimbursement.
· Next is a thorough review of you EOBs. This is where we typically find significant lost reimbursement.
· Looking for denials. How they are processed.
· Comparing reimbursed amounts to the payers "allowed" amounts.
Most practices are billing less than the payers reimbursable amount which results in lost reimbursement.
· Evaluate your claims submission; posting of charges, scrubbing claims
· Evaluate your processing of EOBs; posting payments and handling denials and deductibles.
· We meet with your billers to review all of the above topics.
The last component is a wrap up meeting with you and your staff to review all of our findings and our recommendations for you to meet all compliance requirements and correct any billing and reimbursement issues.
This is followed by a comprehensive report specifically documenting all of the issues we uncovered along with specific recommendations.
Nteon Practice Consultants audits are very comprehensive. All of our clients have thanked us for uncovering what they were never aware of, how to correct these issues, increase their reimbursement and become compliant.