Hauntingly Good Auditing Horror Stories

The wonderful world of auditing often brings up situations that are complex, complicated, and downright scary. We asked for auditing horror stories –  and the auditors delivered!

In the spirit of Halloween, please enjoy these true and terrifying story submissions from across the country.

Be Smart with Smart Phrases

I'm no longer with this employer, but I had a provider that would use a "smart phrase" statement in every patient’s chart when they had reviewed the patient’s glucose diary even if the patient wasn't diabetic. They were on 100% review for a while.

That Name Rings an (Alarm) Bell

I was auditing a chart and submitted a query to the provider for more information regarding diagnosis coding. He was apparently miffed by the query and wrote an addendum at the bottom of the patient chart in response stating: "I was directed by [Named Auditor a.k.a Me] to put this documentation in this patient's chart". Absolutely inappropriate. The chart went straight to the Compliance Officer, and I was mortified by the entire ordeal.

The Ever-Frightening Pulse Oximetry Charge

When working as a hospital auditor, we discovered charges for pulse oximetry!   First, we saw a couple and then as we pulled more samples, more were billed... aaaahhhh!!! That was scary.

A Shocking Post-Lunch Discovery

It was a hot summer day in July. I was asked to travel and perform a new facility acquisition (billing and coding audit) in one of the West Coast regional offices.   I arrived at the office around 12:30 pm to perform the audit. My plan was to set up my laptop and patient charts in the office conference room to perform the audits.

I walked down a long dark corridor that led to the office conference room. I opened the conference room door and to my surprise, there were unconscious people scattered all over the floor.

I began to take a few steps backwards to flee the area in confusion. As I walked backwards in horror and dismay due to this strange and unexpected sighting, I backed up and bumped into the office manager. I exclaimed, “What happened to these poor people!”

The office manager replied, “They are just sleeping; it is a part of their culture to take a nap after lunch.”

I felt like an idiot!

Conclusion: Cultural competency, my fellow auditors, as we engage diverse communities.

An Audit Sparks a Marital Spat

The very scary OB-GYN audit!

Very early in my auditing and physician education career, I performed an audit for a private OB-GYN practice. The practice was very busy, and the office was always a bit chaotic. One of the physicians I audited (and I was auditing 20 encounters per physician) had a very high error rate. The majority of the 20 encounters were “under-coded” by one or two levels of service. In addition, we were using the 1995/1997 documentation guidelines at that time so counting bullets was frustrating but mandatory.

I was eager to meet with the physician and give her the good news and the bad news. Bad news was the low score, but the good news was I could train her to code appropriately and... legitimately increase her revenue.

She was a busy doctor and not the most patient person. You could feel the stress as I sat across her desk to deliver the feedback. I began to review the findings and I could see her become more and more impatient and even angry. We finished the review, and she picked up the phone and asked for someone and proceeded to call them inappropriate names and began yelling at them.

I was so uncomfortable I just wanted to disappear; my pulse raced, I thought of anything I could do to gain control of the meeting.

The physician was extremely angry about the under-coding but went on to apologize to me for her outburst. I tried to console her and explain that we could make this a win-win situation... and in the door comes a man looking very scared (to say the least). As they conversed, I discovered that the person she “chewed out” was none other than her husband who was doing all the coding of the office visits for her. Again, if I could have melted into a pool of goo, it would have been better than sitting in that office.

Well, in the end I was asked to train her husband, which gave me more hours and that eased some of the pain from my horrible memories of that meeting. The long and short of the story was that all ended well, we became friends and celebrated the end of the project with a beautiful Thai feast.

Thank you to the fearless auditors who submitted these stories! We appreciate the auditors everywhere who tackle new and unnerving challenges every day.

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