Self Audit Checklist For Doctors Office Templets

Self audits are essential tools for healthcare facilities in order to reduce Medicare and third-party payer claims denials, improve coding integrity and clinical documentation and save costs.

Medical billing audit checklists involve an organized examination of every aspect of running a medical facility and its reimbursement processes, from patient ID verification to cross-referencing data on claim documents with demographics.

Medical Records
Medical audits are designed to evaluate and screen the quality of patient records at healthcare facilities. This process assesses every step that leads to reimbursement claims in order to ensure compliance with federal, state, and private insurer regulations.

Medical records are crucial tools for doctors in diagnosing diseases and prescribing treatments. Medical records must be legible, accurate, complete and current as they must include information on allergies, drug interactions and health problems such as smoking, alcoholism or substance abuse.

Another crucial consideration should be whether the physician’s coding and billing practices increase the risk of claims denials or audits, such as excessive KX modifier use, unbundling of services and multiple billings that overlap each other.

Billing
Self-audits serve to ensure efficient and compliant operations by reviewing billing processes in tandem with clinical audits. All processes leading to reimbursements are evaluated for compliance with federal and state guidelines as well as private insurer guidelines. An audit is the key to effectively overseeing revenue cycle management at any facility, ensuring all claims are billed and paid accurately, while equipping staff to defend against payment litigations or malpractice suits related to non-compliant billing procedures. Common errors include overuse of KX modifier, exceeding Medicare threshold units of service submission or subpar documentation standards.

Are invalid refund requests and offsets being forwarded promptly to their supporting or designated authority?

Patient Encounters
Patient encounters are the cornerstone of clinical care delivery to any particular individual in any setting, such as an emergency department, home health agency or inpatient hospital setting. Each encounter may occur in either an outpatient clinic, emergency room, emergency department, home health agency or inpatient facility and be further classified into admission, stay or discharge events.

Most encounter types will see the “Chart Review” activity displayed as the leftmost tab, while for admitted patients a banner will indicate this is an inpatient chart.

The participants backbone field can be used to record who or what groups participated in a given encounter, making this field useful for government reporting purposes or tracking patients or encounters over time or associating one encounter with another. Its functionality may be duplicated using statusHistory and subjectStatus elements; however, for longer encounters (e.g. admission tracking) which could last over years this approach is ineffective.

Referrals
Referrals are one of the leading causes of claims denials and post-payment audits by Medicare. An internal referrals audit can identify areas for improvement within your clinic’s billing operation and team training in areas like precertification, medical necessity determinations, coding and local coverage determinations as well as excessive KX modifier usage or more than average number of units billed per therapy session.