By Jackie Stack, CPC, CPC-I, CEMC, CFPC, CIMC, CPEDC
Could any of the following mistakes occur in your practice?
* You forget to charge for an EKG that you performed on your patient
* You forget to charge for a CLIA-waived lab tests even though you purchased the test kits
* You inject a patient with a drug but only charge for the injection
These simple mistakes can cost your practice. Performing a chart audit is an important step to identify missing charges that can be found and prevent the loss of revenue. A chart audit can also give you a good idea of how your practice is doing as a whole.
A chart audit will show how well the charges for services are being captured and how well the staff follows up on denied claims. Take a look at whether the code selection, charge entry, claims sub mission, and payment processes are accurate.
Where and how do you begin? First, try to identify potential areas of concern. For instance, run a report of the EKGs paid during a specific time, compared to how many EKGs were performed. Look at where most of your denials come from: Are they from a specific payer or for a specific service?
When you’ve identified what you want to focus on, begin collecting data. Select a time frame to focus on and select a single, typical office day to review. Look at a date that is at least 90 days in the past. This increases the likelihood that all of the charges for that date have been paid. You will be able to review denials, appeals, and the follow-up work related to these charges.
Gather all of the information that you will need to perform the audit. Superbills, patient account detail, remittance advice from the insurance payers, patient chart, etc. Organize the data in a spreadsheet.
After you perform the audit and identify the areas that are costing the practice, share the results with the physicians, practice manager, and other staff, and discuss possible solutions that will improve the process.
July 23rd, 2012
The 2011-2012 seasonal influenza vaccine payment limits are now available on the Centers for Medicare & Medicaid Services (CMS) website.
The Medicare Part B payment allowance limits for seasonal influenza and pneumococcal vaccines are 95 percent of the Average Wholesale Price (AWP), except where the vaccine is furnished in a hospital outpatient department. Payment for the vaccine furnished in the hospital outpatient department is based on reasonable cost.
Annual Part B deductible and coinsurance amounts do not apply for the influenza virus and the pneumococcal vaccinations.
Payment allowances effective for dates of service between Sept. 1, 2011 and Aug. 31, 2012 are:
- 90654: $18.383
- 90655: $15.705
- 90656: $12.375
- 90657: $6.653
- 90660: $22.316
- 90662: $30.923
- Q2035 (Afluria): $11.543
- Q2036 (Flulaval): $8.784
- Q2037 (Fluvirin): $13.652
- Q2038 (Fluzone): $13.306
- Q2039 (N.O.S.): locally priced
September 29th, 2011