Friday, June 7, 2013

Coloring Between the Lines—Self-Auditing

The Basics
Remember those days in grade school when you were so worried about coloring between the lines?
 
Staying in compliance with the many ambulance service billing rules and regulations is a lot like that. We all have to “color between the lines.”

One of the best ways to get it all right the first time is to take a look for yourself, and that means all ambulance companies must self-audit.

By Definition
So what’s an audit, and how can I do this myself?

Really it’s not all that difficult, because self-auditing requires a big dose of common sense.

An audit is defined as “an examination of records to check their accuracy.” That sounds simple enough. But it’s the “self” part that makes many of our palms sweat.

To conduct a self-audit of your ambulance claims, you first have to pull the records that surround the claims, make it part of your regular habits and start to read.

A Sample
Depending on the size of your organization, you most likely want to pull a representative sample. No one says it has to be a scientific sample, but why not use some logical method to bring your self-audit as close to a reasonable cross-section of your ambulance claims.

For example, you can do a calendar sample by pulling all the claims from every third day. Maybe you want to pull every other BLS Emergency claim this week and then next week pull every fourth ALS Emergency and conduct a level of service type self-audit.

We don’t think it matters too much which claims you pull, but the act of pulling and reviewing means that you are starting to get a look at what’s going on. You’ll begin to see real quickly what’s working and maybe what’s not working.

This is how you’ll know where you’re coloring outside the lines.

Before it’s Billed

One of the best ways to head off a problem at the pass is to review your service’s Patient Care Reports before those PCR’s head off to the billing office.

You can take a quick look for a number of things pretty easily, and that review may save you a lot of grief down the road.

For example, without too much effort on your part, you can review the subjective narratives of the PCR’s that you selected. Read those narratives and ask some quick questions. You may want to prepare a simple one-page list of check-off items to help you sift it all out.

Ask critical questions. For instance, has the provider who authored the PCR included enough information to allow the billing office to see a clear picture of the incident? Using our color between the lines analogy, ask the question, “Has the provider painted a picture in words about this scenario?”  There must be adequate information written in the subjective narrative about the incident to assist your billing office in determining the patient’s medical necessity. 

If the subjective narrative is lacking basic information, you can stop there. Nothing else will matter. It’s about as basic a principle as we get in this business.

Of course, we don’t have the space in this one blog to go over all the questions you can ask. But we think you get the concept, and hopefully you get a sense that this isn’t all that difficult. Quite frankly, the exercise of simply taking a look puts you on the right course for compliance success.

If you don’t review you’ll have no way of sifting out compliance risks that may exist within your organization.

Switch it Up
Just to break up the monotony of the task, switch it up and take a look at different bits of information each time.

This week you may want to review all the patient signature forms to ensure that they are being adequately completed and represent your patient population correctly. Quite simply, you may find that your patient signature completion rate isn’t as good as you thought it was when you keep a simple tally of signatures obtained versus no signatures obtained.

Next week, switch it up and go back to reviewing PCR narratives for medical necessity documentation.

The following week, you can spend some time reviewing Physician Certification Statements (PCS’s or the “Medical Necessity” forms) for such things as proper medical professional signatures, medical necessity accuracy, etc.

Ask yourself; “What area am I most worried about?” That’s a great place to start your self-audit task.

An Ounce of Prevention
The possibilities are limitless, so sometimes the task may seem daunting. However, getting into a habit of self-auditing is a huge ounce of prevention.

The only way you can ever identify a compliance risk for your ambulance service and nip that risk in the bud before it causes you a big problem is to take a look. Develop a habit of regular self-auditing and you’ll sleep better at night.

We Do It
Any reputable billing company establishes a habit of conducting self-audits. Enhanced Management Services constantly views and reviews all aspects of our processes and procedures to benefit all of our clients.
 
Remember, Enhanced is “fanatical” about compliance!

So not only do Enhanced Management Services clients have the benefit of a line of defense at the billing company level, but those clients who self-audit have now doubled their efforts to avoid compliance risks at each level- both before your PCR arrives in our office and after it arrives in our office.

If you’re billing office, in-house or outsourced, isn’t helping to guide you regarding potential compliance risks, then it’s time to take a look at another billing solution.

Why not take a look at Enhanced for that extra level of oversight?

Business Development Manager, Chuck Humphrey is ready to hear from you. Contact him today to learn how you can learn how to begin a self-audit trail that will then be extended by that second line of defense, the Enhanced way. 

You can reach Chuck via e-mail at chumphrey@enhancedms.com or pick up the phone and call him today at 1-800-369-7544, Extension 108.
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