One of the most difficult jobs as an auditor isn’t keeping up with the constant changes in healthcare or trying to remember all the rules for the different Medicare carriers. It’s sitting down with a provider to discuss their audit results.
When we audit a provider and their documentation isn’t meeting guidelines, we have to have a discussion about how they can improve.
Approach From the Doctor’s Perspective:
The first thing to remember when setting a meeting is that a doctor is there to be a doctor. They received training to take care of patients, not code.
Let Providers Express Frustration:
Let your provider express their frustration and calmly remind them that you didn’t create the rules. You’re merely the conveyer of the information and you’re applying the rules as per the guidelines. Explain the edits as they apply to their particular procedures and show them the edits and the CCI manual guidelines. Again, visual documentation always helps to explain.
Show Providers Penalties for Incorrect Documentation:
During a re-audit if the provider still hasn’t taken your advice, it can be helpful to show them case examples where providers received penalties for incorrect documentation. Discuss what the next course of action will be if they continue to knowingly document incorrectly. Be firm but always be polite.
Remember that doctors are not auditors.
Download my free eBrief, Provider Assessment Plan: Quick and Easy Tips for Auditors, to get the full scoop on how to have an effective conversation with providers that gets results. You’ll learn how to: