Does even seeing the word “audit” produce an emotional response?
When you get your audit request, make sure you understand who made the request and why. Some audits are simply random. Your number came up. No big deal.
In other cases, your billing may havecreated a red flag. If so, it’s crucial to understand why so you can avoid the needless hassle and distraction in the future.
Here are some of the most common reasons for an audit:
Patterns of care – Does every new patient get the same treatment plan, and pattern of care? Are you able to adequately defend your identical recommendations?
Treatment date – If your CMS 1500 billing forms have dates in Box 14 (initiation of treatment) that show more than two months of care for every condition, this has probably put you on an auditor’s radar screen.
Overuse of high-paying codes - We’ve seen practices with as much as 60% - 97% of 98941 (3-4 spinal regions) codes. This tells a reviewer (or computer algorithm) that you may be treating more areas than the typical chiropractor. And statistics show that your documentation can’t support it.
Someone’s got a grudge - A disgruntled employee knows about your billing practices. While you may not have done anything wrong, being reported to a carrier or Medicare will likely trigger an audit.
We recommend that you regularly perform internal audits before receiving a letter demanding patient records. The audit process is not difficult and surprisingly affordable.
The question is no longer if you will be audited, but when. Protect yourself with the peace of mind of knowing that when your number comes up, you'll be ready.