With the countless challenges that impact healthcare as well as current COVID pandemic that has us preoccupied, it has never been more important to properly document your clinical services to satisfy reporting requirements for the procedures, supplies and medical services.
Today, with Medicaid expansion and the skyrocketing cost of commercial healthcare, many FQHCs are serving all kinds of patients, not just those with low income. Due to the varying types of services performed at FQHCs, it is vitally important that the documentation and coding of the medical records is complete and accurate.
Often the procedures executed in practice may not follow compliance and coding regulations. The accuracy of billing must reflect quality of care which is provided to your customers.
In most FQHCs there is an internal Compliance Department responsible for conducting internal audits. Medical practices audit for two primary reasons: 1. Ensure billing for services rendered are accurate. 2. Follow state and federal regulation.
Reduced reimbursements and revenues and heavy regulatory requirements make regular auditing essential. Every healthcare organization should consider their practice as a business. Successful organizations follow the simple and prudent steps necessary to help their business thrive.
However, it is always best practice to bring an outside firm to review a random sample of services to validate coding and compliance practices. An external review will identify any potential issues and/or validate provider documentation.
Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) recommend that health care providers routinely enlist independent parties to audit coding practices. Many health care organizations welcome these audits as a way to obtain feedback regarding their coding programs, in large measure to improve quality.
Whether you are trying to assess and mitigate the risk your providers may be currently exposing your facility or if you are trying to respond to an insurance company’s demand for refund or documentation requests, An audit cycle is one of the best ways to ensure the ongoing health of a practice. An audit will confirm that your practice is efficient. It identifies areas that need to be strengthened. The reality is that there is opportunity for growth and improvement in virtually every medical practice.