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Use your compliance audits to improve cash collections

Betsy Nicoletti

 When it comes to your annual coding compliance audits, you have two choices:  grit your teeth and get them over with or use them as an opportunity to find lost revenue, discover and solve problems in your revenue cycle and fulfill your compliance obligations at the same time.


I frequently find services that were provided and documented but not billed when I perform compliance audits for my clients.  It's easy to dismiss these as single, one-time errors.  But, I suspect that they represent recurring problems, not one-time errors.  Repeatedly neglecting to bill for services done and documented results in lower cash collections to the practice.  What's worse, you have incurred the expense to provide the service!


Here are a few examples of lost revenue I find while doing compliance audits:


Lab services not billed:  CLIA waived tests are done, documented in the medical record and reported to the patient, but not billed to patient or insurance company. 


Incorrect units:  One unit of medicine is billed, when the correct dosage per the HCPCS defines the amount given to the patient is 2 units, or 10 units, or 100 units.  The practice paid for all of the units billed, but incorrectly bills for a lower dosage than provided.


Procedures:  Some physicians and providers believe that for all insurance companies, only one service can be billed: the Evaluation and Management service or the procedure.  They perform and document both, but bill one.  I have also found the modifier applied to the wrong procedure, and the charge written off when the insurance denies it.


Hospital services:  The charge capture process for out of office services lacks controls in many practices.  On audit, I find wrong dates of service, and no service billed for hospital visits.


When you do your compliance audits, be on the look out for these lost billing opportunities.  If you find the error once, actively look at your revenue cycle processes, identify why the charge wasn't billed and implement changes to capture those charges every time they are billed.


The easiest money your practice will ever make is by billing for services already done.