Internal monitoring of physician billing and coding

Physian practices should always be aware of any and all internal risks identified in the past that need to be monitored. Internal monitoring of some of the areas below can also help to identify potential billing and coding compliance risks:

– Medical record requests received by the practice from external entities (e.g., RAC, MAC, CERT, OIG, Medicaid Integrity Contractors, others). These can include routine additional documentation requests, prepayment reviews, postpayment audits, etc.

– Repeated denials for the same type of claim error may be considered submission of false claims.

– Benchmarking of billing patterns by physician, by specialty, and in comparison to other physicians within your system, or using outside data, such as CMS or other commercially available data can allow a practice to identify physicians who are outliers in comparison to their peers.

Internal monitoring can help a practice focus its auditing on the identified potential risk areas. No matter what size a practice you are, you need realize billing and codinig compliance risks can lurk anywhere. Just remember the key to any compliance activity is to:

1. Prevent

2. Detect

3. Correct

About the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.