Many people are intimidated by the word “audit” and run in the other direction. Why should every practice do chart audits? It is important to inspect and verify your charts and billing practices before an insurance company calls for medical records. Doing regular chart audits sets you up for a sense of calm when the auditors do come knocking. Audits help you learn more about billing, the hierarchy of treatment, and what to expect from an insurance company before you send the claim.
When a patient is finished with treatment, the documentation needs to be matched up with the billing. It is not unusual to perform ‘spot’ audits during a course of treatment and helps the final audit process go very smoothly. A billing ‘roadmap’ or guideline is a handy tool to have available. If you use a billing guide, be sure to exercise flexibility in auditing, due to patient factors. There are no hard and fast rules when billing radiation oncology services, because every patient is different.
First, read the original consult notes to gain understanding of the patient history, the current diagnosis, medications, and the treatment plan. You are going to use this information to form a logical sequence of events.
Next, sort the billed charges by date and read over the CPT codes. They should follow a pattern, such as pre-planning stage, treatment weeks, boost planning, etc. The dates in billing should match the documentation in the patient’s chart. Exceptions to this are acceptable (within a day or two), as long as the practice consistently bills the same way for all patients.
Pay attention to the units billed and match the number of beams or tangents with dosimetry charges, or the number of blocks with units billed for the immobilization device(s).
Count the number of treatments that were expected to be given, the number that were billed, and the number reported in the final completion note. In a perfect world, all should match, but patients get sick, discontinue treatment, or other events can change a treatment course. Just document on a checklist or in the final treatment notes what caused the discrepancy so you will remember later.
Verify that every weekly treatment management charge that you billed has a doctor’s report, and that the number of treatments divided by five equals the number of treatment management codes billed. However, keep in mind that you may have three or more additional treatment deliveries at the end of the patient’s treatment course that would result in one additional weekly treatment management charge. The date ranges for your weekly treatment management charges cannot overlap.
Also count any port films and weekly physics codes and match them to your documentation and the number of treatments received. Many of these documents may come from different departments. Check that all documents have been signed, initialed, or electronically signed by the doctor who is overseeing treatment.
At this time, I also like to look at the payments and/or denials that have been received in the patient’s A/R’s. This gives me an opportunity to share any research that can guide my A/R or billing person as to the reason why a service was denied improperly or should not have been billed. It becomes apparent which services will always be bundled if billed together, or which services may require a modifier. Refund situations can also be quickly identified and you will be in the good graces of any insurance company when you voluntarily send a refund for a billing error.
Basically, when you perform a chart audit, you are making sure that every billed charge has a document to support its existence. If you use a billing guideline or checklist, it can be included in the chart with notes or exceptions that you would like to remember later, such as why a code was not billed or why a patient did not receive the number of treatments originally planned. This way, if a chart does get pulled for an external audit, the internal audit checklist can really take the pressure off and you are not scrambling to find explanations for any inconsistencies. A typical internal chart audit takes only 15 – 20 minutes and is well worth the time in the long run.