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CODING & BILLING
Karlene Dittrich, CBCS
Beware the Auditors' Dirty Tricks
Proper coding alone isn't always enough to protect earned revenue.
A
uditors are getting increasingly
brazen. We're seeing more medical
record requests, retroactive denials
and significant payment demands from them.
Could it be because some insurers are using
audits ostensibly designed to locate and
Unsuspecting
providers still
fall prey to
disingenuous
attempts of claim
denial and
refund demand
practices.
address "fraudulent or abusive" billing and
coding practices for financial gain?
Take extrapolation, for example. Auditors
recently visited a surgery center and examined 80 medical records. Out of 80, they found 2 records that were overcoded,
2 that were undercoded and 1 in which the op note wasn't signed.
Rather than asking the center to refund the overcoded claims and the
unsigned op note, the auditors asked the center to pay a percentage of all
claims. We're talking $64,000 instead of $3,000. That's extrapolation,
although some might call it extortion. Oh, those 2 undercoded claims?
Auditors told the ASC not to rebill those until they were instructed to.
Safeguarding what's rightfully yours
Yes, protecting earned revenue has never been more challenging. Proper coding alone is not enough these days.
Not all auditors may act in good faith. Auditors with a focus on financial
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O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | O C T O B E R 2012
