There isn’t a chiropractor alive who doesn’t shudder at the thought of being audited. The feeling that every payment request is being scrutinized for the slightest error is a huge pressure, but it can be lessened by proactively prepping and managing the process yourself.
The more thorough you are about in-house documentation, the less chance that auditors will call you out for a refund. Put these best practices in place as part of your everyday operations and you’ll feel much less apprehensive about justifying expenses.
Set a Baseline
Starting from the bottom up helps you discover if your practice is getting the basics right. Exposed weaknesses will help you create a road map on how to be better prepped for audits. Begin with coding: products, supplies, and services all require the proper HCPCS codes. These are updated annually so it’s vital your team stays up to date. Don’t forget that there were other big changes in coding that came into play this year.
After accuracy comes clarity. Does everyone in your practice have neat handwriting? Scrawled dates, codes, and signatures are very hard for auditors to read which can lead to them to question your records. Make everything you write legible beyond doubt. Better yet, record everything digitally on chiropractic software and electronic health records. Your data will be crystal clear, and it can be backed up in the cloud or on removable devices to prevent loss.
Next, make sure every service you provide to patients is necessary as per the payer’s guidelines. These guidelines may vary from payer to payer based on their individual medical policies. Diagnoses must match procedures in every instance, and treatment must only last as long as it is considered medically necessary, again, often according to the payers’ guidelines. Every patient should have a care plan drawn up after your consult and examination that outlines your plan of, along with timelines. Progress will be organic, of course, but if a payer audit is triggered, you’ll be able to prove that you had purpose, direction, and an end goal and weren’t just aimlessly prolonging treatment.
Manage Audits Through Confident Challenge
An eye-opening article by The Strategic Chiropractor reveals some very lax practices on the part of auditors. From note requests and vague descriptions to bundling, extrapolated refunds, and shaky credentials, there’s a lot for practices to challenge when an audit letter arrives.
Managing an audit can involve contesting it in court; an unpleasant and expensive scenario that may sway some chiropractors into accepting they’re “wrong” to avoid further hassle. However, if you’ve implemented a compliance plan that self-monitors practice procedures, clearly defines policy and performance expectations, and takes action against internal violations, then you’re in a stronger position to challenge payer audits. The good news is, when you have your records in order, you have a great chance of winning.
ChiroHealthUSA Can Help You Get Your Practice Ready
Solid preparation empowers you to respond promptly and confidently to a payer audit. ChiroHealthUSA is here to help pre-and post-audit. We provide a documentation audit package as part of ChiroArmor, and up to $1 million in protection through CHUSAdefense in case your audit results in fines, legal defense costs, or other regulatory expenses.
We’re here to protect you and your practice so you can provide compassionate, compliant care. Connect with us today for more information.
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Dr. Ray Foxworth is a certified Medical Compliance Specialist and President of ChiroHealthUSA. A practicing Chiropractor, he remains “in the trenches” facing challenges with billing, coding, documentation and compliance. He has served as president of the Mississippi Chiropractic Association, former Staff Chiropractor at the G.V. Sonny Montgomery VA Medical Center and is a Fellow of the International College of Chiropractic. You can contact Dr. Foxworth at 1-888-719-9990, info@chirohealthusa.com or visit the ChiroHealthUSA website at www.chirohealthusa.com. Join us for a free webinar that will give you all the details about how a DMPO can help you practice with more peace of mind. Go to www.chirohealthusa.com to register today.
